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THE
AMERICAN JOURNAL
OF THE
MEDICAL SCIENCES
No. XXVII.— May, 1834. 1
COLLABORATORS.
M
Jacob Bigelow, M. D. Professor of
Materia Medica in Harvard Univer-
sity, Boston.
Edward H. Baktout, M. D. of New
Orleans.
PIe^trt Bkonsoi?-, M. D. of Albany , New
York.
Walter Channikg, M. D. Professor of
Midwifery and Legal Medicine in
Harvard University, Boston.
N. CnAPMA]!f, M, D. Professor of the
Institutes and Practice of Physic and
Clinical Practice in the University of
Pennsylvania.
JoHjf Redman Coxe, M. D. Professor
of Materia Medica and Pharmacy in
the University of Pennsylvania.
D. FRA]<rcis Condie, M. D. of Phila-
delphia.
William C. DA:NriELL, M. D. of Savan-
nah, Georgia.
William P. Dewees, M. D. Adjunct
Professor of Midwifery in the Univer-
sity of Pennsylvania.
S. Hekrt Dickson, M. D. Professor of
the Institutes and Practice of Medicine
in the Medical College of the state of
South Carolina.
Benjamin W. Dudley, M. D. Profes-
sor of Anatomy and Surgery in Tran-
sylvania University.
Gouverneur Emerson, M. D. of Phila-
delphia.
Paul F. Eye, M. D. Professor of Sur-
gery in the Georgia Medical College.
John W. Francis, M. D. Late Profes-
sor of Obstetrics and Forensic Medi-
cine in Rutgers Medical College, New
York.
W. W. Gerhard, M. D. of Philadelphia.
WiEEiAM Gibson, M. D, Professor of
Surgery in the University of Pennsyl-
vania.
R. E. GmTmTn^M.I). of Philadelphia.
E. Hale, M. D. of Boston.
Robert Hare, M. D. Professor of Che-
mistry in the University of Pennsyl-
vania.
George Hay ward, M. D. Junior Sur-
geon to the Massachusetts General Hos-
pital.
Thomas Henderson, M. D. Professor
of the Theory and Practice of Medi-
cine in the Columbian College, Dis-
trict of Columbia.
William E. Horner, M. D. Professor
of Anatomy in the University of
Pennsylvania.
Dayid Hosack, M. D. Late Professor
of the Institutes and Practice of Medi-
cine in Rutgers Medical College, New
York,
Ansel W. Ives, M. D. of New York.
Samuel Jackson, M. D. Assistant to the
Professor of the Institutes and Practice
of Medicine and Clinical Practice in
the University of Pennsylvania.
Samuel Jackson, M. D. of Northum-
berland, Pennsylvania.
Valentine Mott, M. D. Professor of
Pathological and Operative Surgery
in the College of Physicians and Sur-
geons, New York,
James Moultrie, Jr. M. D. Professor
of Physiology in the Medical College
of the state of South Carolina.
Reuben D. Mussey, M. D. Professor
of Anatomy and Surgery in Dart-
mouth College, New Hampshire,
T. D. Mutter, M. D. of Philadelphia.
R. M. Patterson, M. D. Professor of
Natural Philosophy in the University
of Virginia.
Philip Syng Physick, M. D. Profes-
sor of Anatomy in the University of
Pennsylvania.
Thomas Sewall, M. D. Professor of
Anatomy and Physiology in the Co-
lumbian College, District of Colum-
bia.
AsHBEL Smith, M. D. of Salisbury,
North Carolina.
A. F. Vache, M. D. of New York.
John Ware, M. D. Assistant Professor
of the Theory and Practice of Physic
in Harvard University, Boston.
John C. Warren, M. D. Professor of
Anatomy and Surgery in Harvard
University, Boston.
J. Webster, M. D. Lecturer on Ana-
tomy and Surgery, New York.
Thomas H. Wright, M. D. Physician
to the Baltimore Aims-House Injir'
mary.
editor—Isaac Hays, M. d.
THE
AMERICAN JOURNAL
MEDICAL SCIENCES
VOL. XIV.
PHILADELPHIA:
CAREY, liEA & BliASrCHARD.
1834.
c^iViHSOfv^-,,
TO READERS ^ND CORRESPONDENTS.
Communications have been received from Drs. Chapman, Jackson, Parrish,
Daltopt, Monett, Miller, Dickson^ Finlet, and Perrine.
The following- works have been received:-—
Transactions of the Medical and Physical Society of Calcutta, Vol. VI. Cal-
cutta, 1833. (From the society.)
The Value of a Great Medical Reputation, with Suggestions for its Attain-
ment; a Lecture, Introductory to the Summer Course of the Medical Institute.
By John K. Mitchell, M. D., Lecturer on Medical Chemistry in the Philadel-
phia Medical Institute. Philadelphia, 1834. (From the author.)
Catalogue of the Trustees, Faculty and Students of the Medical Department
of the University of Maryland. Baltimore, 1834. (From Professor Geddings.)
An Exposition of the Affairs of the Medical Society of South Carolina, so far
as they Appertain to the Establishment of a Medical College in Charleston,
and the Subsequent Division of the Latter into two Schools of Medicine. Pub-
lished by order of the Medical Society. Charleston, 1833. (From the Secretary
of the Society.)
An Address, Introductory to a Course of Lectures, Delivered in the Hall of
the Medical Society of South Carolina, before the Trustees and Faculty, the
Students of Medicine, and the Public generally, at the Opening of the Session
of 1833-4. By John R. Rhilanber, M. D. Professor of Anatomy. Charleston,
1834. (From the author.)
Tables Exhibiting the Doses and Properties Ascribed to the Principal Me-
dicines and Officinal Preparations. For the Use of, the Medical Class of the
University of Maryland. By Professor Dtjnglison. (From the author.)
An Address, Delivered to the Graduates in Medicine, at the Commencement
of the University of Maryland, on Wednesday, March 19th, 1834. By Professor
DxjNGLisoN. Published by the Graduates and Students. Baltimore, 1834. (From
the author.)
The Medico-Chirurgical Review, for January, 1834. (In exchange.)
The London Medical Gazette, for December, 1833, January and February,
1834. (In exchange.)
The Edinburgh Medical and Surgical Journal, for January, 1833. (In ex-
change.)
The London Medical and Surgical Journal, for November and December,
1833. (In exchange.)
The Transylvania Journal of Medicine and the Associate Sciences, from Oc-
tober to December, 1833. (In exchange.)
1*
VI TO READERS AND CORRESPONDENTS.
The Medical Magazine, for January, February, and March, 1834. (In ex-
change.)
The Boston Medical and Surgical Journal. (In exchange.)
The Western Journal of the Medical and Physical Sciences, January, 1834.
(In exchange.)
The Western Medical Gazette, Nos. 19, 20, 1834. (In exchange.)
Memorial Encyclopedique et Progressif des Connaissances Huraaines, Stc.
January to September, 1833. (In exchange.)
For the gratification of our contributors we present references to the works,
recently received, in which their communications are noticed.
Professor Mott will find his case of Excision of Tuberculous Sarcoma from
the Neck, noticed in the Gazette Medicale de Parisj Sept. /"th, 1833, and his
case of Aneurism of the Arteria Innominata, in the Glasgow Medical Journal,
for May, 1831.
Professor Wahkex's case of Non-existence of Vagina Is copied in the Boston
Medical and Surgical Journal, for November 20th, 1833; and his case of Exci-
sion of Osteo-Sarcomatous Clavicle in the Western Medical and Physical Jour-
nal, for January, 1834.
Professor HoajfER's Experiment on the Vascular Connexion of Mother and
Foetus is noticed in the Cincinnatti Medical Gazette, for Sept. 1st, 1833; and
his case of Ligature of primitive Carotid in the Archives Generales, April, 1833.
Dr. Jackson's cases of Croup are noticed in the Glasgow Medical Journal,
for January, 1833.
Dr. S. Jackson's Observations on the Use of Cold Water in Scarlatina Ma-
ligna are noticed in the Boston Medical and Surgical Journal, for October 16th,
1833, the Western Journal of the Medical and Physical Sciences, for October,
1833, the liOndon Medical and Surgical Journal, for August, 1833, and in the
Gazette Medicale de Paris, September- 7th, 1833; his paper on the Use of Rhu-
barb in Haemorrhoids is noticed in the Glasgow Medical Journal, for January,
1833.
Dr. Hodge's Memoir on Puerperal Fever is noticed in the Western Journal
of the Medical and Physical Sciences, for October, 1833.
Dr. J. K. Mitchell's cases of Rheumatism are noticed in the Western Jour-
nal of the Medical and Physical Sciences, for October, 1833; and his case of
Spasm cured by Ligature in the Archives Generales, April, 1833.
Dr. Pekrine's observations on the Use of Large Doses of Quinine are noticed
in the Transylvania Journal of Medicine, for July, 1833.
Dr. Fahnestock's case of Partial Congestion of Cerebrum is copied in the
Transylvania Journal of Medicine, for July, 1833, and in the Gazette Medicale
de Paris, for September 7th, 1833.
Dr. Wright's observations on Hospital Gangrene are noticed in the Medical
Magazine, for August, 1833; and his Illustrations of Cardiac Pathology in the
TO READERS AND CORRESPONDENTS. VII
London Medical and Surgical Journal, for August, 1833, and in the Gazette
Medicale de Paris, for September, 1833.
Dr. C. A. Lee's observations on Cold Dash in Nervous and Convulsive Dis-
eases are noticed in the Cincinnatti Medical Gazette, Vol. I. No. 17, and in the
Western Journal of the Medical and Physical Sciences, for October, 1833.
Dr. W. M. Lee's case of Splenitis is noticed in the Cincinnatti Medical Ga-
zette, Vol. I. No. 17.
Dr. Griscom's account of the Apocynum Canabinum is noticed in the London
Medical Gazette, for November, 1833, and in the Gazette Medicale de Paris,
for September 7th, 1833.
Dr. Mettaueh's case of Parturient Laceration of Recto-vaginal Septum is
copied in the Boston Medical and Surgical Journal, for November 20th, 1833.
Dr. Robis"sok's case of Monstrosity is noticed in the Gazette Medicale de
Paris, for September 7th, 1833.
Dr. Williams' case of Stricture of Vagina is noticed in the Gazette Medicale
de Paris, for September 7th, 1833.
Dr. Heustis' case of Prolapsus of Rectum is noticed in the Gazette Medicale
de Paris, for September 7th, 1833.
Dr. Ward's case of Vagltus Uterinus is noticed in the Gazette Medicale de
Paris, for September 7th, 1833.
Dr. ZoLLicKorFEB's remarks on the Euphorbia Corollata are noticed in the
Gazette Medicale de Paris, for September 7th, 1833.
Dr. Youkg's remarks on the Use of Cimicifuga Racemosa in Chorea are no-
ticed in Broussais' Annals, for December, 1833; in the Glasgow Medical Journal,
for January, 1833; in the Western Journal of Medical and Physical Sciences,
for January, 1834; and his case Illustrative of the Use of the Cold Affusion for
the recovery of persons struck with lightning is noticed in the Western Journal
of Medical and Physical Sciences, for January, 1834.
Dr. Atlee's remarks on the Use of Prussic Acid in Hooping-Cough are no-
ticed in the Gazette Medicale de Paris, for January 31st, 1833.
Dr. Wells' case of Tracheotomy for the Removal of a Foreign Body is no-
ticed in the Glasgow Medical Journal for January, 1833.
Dr. Baldwin's case of Tetanus treated with success is noticed in the Gazette
Medicale de Paris, for September 7th, 1833.
Dr. Pohcher's case of Retained Placenta is noticed in the Transactions Me-
dlcales, for April, 1833, and in the Gazette Medicale de Paris, for July 13th,
1833.
Dr. Picton's observations on the Utility of Excluding the Light, to prevent
Pitting from Small-pox, are noticed in the Gazette Medicale de Paris, for
February 5th, 1833. '
Dr. Vale:'s cases of Traumatic Tetanus are noticed in the Boston Medical
and Surgical Journal, for January, 1833.
Vlll TO READERS AND CORRESPONDENTS.
Dr. Younge's remarks on the Utility of Calomel in Pruritis, are noticed in the
Boston Medical and Surgical Journal, for December 25th, 1833.
Dr. Joslin's observations on Vision are copied in the Archives Gen^rales,
for February, 1833, and noticed in the Ann. de la Med. Phys. for March, 1833.
Dr. Parrish's paper on Spinal Irritation is noticed in the Archives Generales,
for March, 1833, in the Review Medicale, for June, 1833, in the Transactions
Medicale, for April, 1833, and in Anp. de la Med. Phys. for April, 1833.
Dr. Hall's case of Extirpation of Testicle is noticed in Archives Generales,
for March, 1833.
Dr. AifDERsoN's case of Amputation of Lower Jaw is noticed in Archives
Generales, for April, 1833.
Dr. Le Beau's case of Precocious Puberty is noticed in the Revue Medicale,
for June, 1833.
Dr. Mo?fETT's observations on the Sulphate of Quinine, are noticed in the
Western Journal of Medical and Physical Sciences, for January, 1834.
Dr. Labriskie's case of Amnesia is noticed in the Boston Medical and
Surgical Journal, for March 12th, 1834, and his case of Pityriasis rubra in the
same journal.
Authors of new medical books, desirous of having them reviewed or noticed
in this Journal at the earliest opportunity, are invited to transmit to the Editor
a copy as soon after publication as convenient, when they will receive prompt
attention. Under ordinary circumstances, very considerable delay is caused by
the circuitous routes through which they are received.
Papers intended for publication, should be sent, /ree of expense, as early after
the appearance of the Journal as possible, in order to be in time for the ensuing
number. Such communications should be addressed to *' Caret, Lea & Blan-
CHARB, Philadelphia, for the Editor of the American Journal of the Medical
Sciences."
All letters on the business of the Journal to be addressed exclusively to the
publishers.
CONTENTS.
ORIGINAL COMMUNICATIONS.
ESSAYS.
Art. Page.
I. Observations of the Remedial ElTects of the Balsam of Copaiba in Ca-
tarrh and Irritability of the Bladder, and in Leucorrhoea? with Cases. By
R. La Roche, M. D. of Philadelphia 13
II. Cases of the Epidemic Yellow Fever prevalent at New Orleans in the
Summer and Fall of 1833. By E. B. Harris, M. D. [Communicated to
Dr. Samuel Jackson, of Philadelphia] 41
III. Cases of Gastritis Superinduced. By Thomas J. Charlton, M. D. of
Georgia 74
IV. Thoughts on the Bilious Remittent, commonly called Congestive
Fever. By Theodore Bland Dudley, of Alexandria, Louisiana - 76
V. An Account of a New Instrument for Operating in Cases of Fistula in
Ano. By Thomas D. Mutter, M. D. one of the Physicians to the Phila-
delphia Dispensary, Sec. --------- 80
VI. A Case of Hepatic Abscess, in which Tapping was Performed before
Adhesion of the Liver to the Side had occurred; and the Appearances
after death. By W. E. Horner, M. D. Professor of Anatomy in the Uni-
versity of Pennsylvania 87
VII. Case in which Sand was voided by the Mouth, Rectum, Urethra,
Nose, Ear, Side, and Umbilicus, and attended by various other Anoma-
lous Symptoms. By C. Ticknor, M. D. of New York . . - 91
VIII. Case of Purpura Hsemorrhagica. By Samuel Jackson, M. D. Assist-
ant to the Professor of the institutes and Practice of Medicine in the
University of Pennsylvania -------- 95
IX. Cerebral Affections of Children. By W. W. Gerhard, M. D. (Second
Part) - . . 99
X. Description of a New CEsophagus Forceps. By Constantine Weever,
M. D. of Detroit - 111
XL On the Efficacy of a Mixture of Camphor and Muriate of Ammonia in
the Treatment of Suppression of Urine. By Alexander Somervail, M. D.
ofLoretto, Essex County, Virginia 113
XII. Cases of Neuralgia, with Remarks. By W. A. Gillespie^ M. D. of
Louisa, Virginia - - J15
REVIEWS.
XIII. Experiments and Observations on the Gastric Juice, and the Phy-
siology of Digestion. By William Beaumont, M. D. Surgeon in the
United States' Army. Plattsburgh, 1833. 8vo. pp. 280 - - - 117
XIV. On the Influence of Physical Agents on Life. By W. F. Edwards,
X CONTENTS.
Art. Page.
M. D., F. R. S., Member of the Royal Academy of Sciences, and Royal
Academy of Medicine of Paris, of the Philomathic Society of the same
city, and of the Medical Society of Dublin, &,c. Translated from the
French, by Dr. Hodgkin and Dr. Fisher. To which are added, in the
Appendix, Some Observations on Electricity, by Dr. Edwards, M.
Pouillet, and Luke Howard, F. R. S.5 On Absorption, and the Uses of
the Spleen, by Dr. Hodgkin; on the Microscopic Characters of the Ani-
mal Tissues and Fluids, by J. J. Lister, F. R. S. and Dr. Hodgkin; and
Some Notes to the work of Dr. Edwards. London, 1832. 8vo. pp. 488 150
BIBLIOGRAPHICAL NOTICES.
XV. A New Exposition of the Functions of the Nerves. By James William
Earle. Parti. Longman, Rees, & Co. 1833 188
XVI. Nouvel Apercu sur la Physiologie du Foie et les Usages de la Bile. De
la Digestion Consideree en General. Par Benjamin Voisin, D. M. P.
Paris, 1833. pp. 146.
New Observations upon the Physiology of the Liver and the Uses of the
Bile, and upon the General Subject of Digestion. By Benjamin Voisin,
M. D - 201
XVII. Dictionary of Practical Medicine, &c. By James Copland, M. D.
Parts I., II. 8vo. London, 1833-4 209
XVIII. Essai sur le Madar, (CalotropisMadariilndico-orientalis,) contenant
FHistoire Naturelle de cette Plante, ses proprietes Physiques, Chimiques
et Medicinales. Par J. N. Cassanova, C. M. D. &c. &c. Calcutta, 1833.
pp. 69. 8vo. -.-..--►-.- 213
QUARTERLY PERISCOPE
FOREIGN INTELLIGENCE.
ASTATOMT.
Page.
1. Case of Malformation — Absence
of Anus — Recto-Vaginal Canal.
By M. Ricord - - - 215
Page.
2. On some points of the Anatomy
of the Eye - - - 216
3. Anomaly in the Venous System.
By M. Pexgot - - - 218
Phtsioiogt.
Tubercles Developed in the
Origins of tlie Tliird, Fifth, Se-
venth, and Eighth Nerves — loss
of Hearing, Sight, and Smell —
Preservation of the Sense of
Taste, and of the Sensibihty of
the Integuments of the Face.
By M. Nelaton - - - 219
5. Functions ofthe Lingual Nerves.
By MM. Choisy and Montault 219
6. Instance of Superfoetation - 220
7. Life and Respiration continued
after the total Destruction ofthe
Brain. By Dr. Beyer - - ib.
CONTENTS.
XI
Pathology.
Page.
8. Case of Anoerala of the Kidney.
By James Wynn, Esq. - 220
9. Case of Hypertrophy of the
Muscular Coat of the Stomach.
By Dr. Otto - - - 221
10. Observations on Epidemic Gas-
tric Fever, as it appeared in Li-
merick Garrison during the
Months of May, June, and July,
1833. By Richard Poole, Esq. 222
11. Case of Paraplegia dependent
on Chronic Inflammation of the
Spinal Cord. By Dr. Craigie - 227
12. Case of Myehtic Paraplegia
depending upon Disease of the
Bodies of the Vertebrae. By Dr.
Craigie - - - - 229
13. Case of Periostitis with Ozrena.
By David Craigie, M. D. - 230
14. Case of Meningeal Apoplexy.
By M. Alegre - - - 232
Page.
15. Case of Apoplexy of the Spi-
nal Marrow. By M. Monod 232
16. Case of Meloena with the Dis-
section. By David Craigie, M. D. ih,
17. On the Pendulous Tumour of
the External Ear. By Dr. A.
Campbell - - - 234
18. Swelled Leg resembling Phleg-
masia Dolens, and Obliteration
of the Iliac Vein. By J. C. Bos-
well, Esq, .... ib.
19. Case of Engorgement of the
Occipital and Vertebral Liga-
ments— Palsy and Atrophy of
the Left Half of the Tongue.
By M. Dupuytren - - 235
20. Remarks on Local Diseases —
Pathology of the Diseases of the
Digestive System. By William
Stokes, M. D. - - - 237
Materia Medica.
21. Formulae for Preparations of
Hydriodate of Iron. By M. Pier-
quin
22. Ointment for the Cure of Por-
rigo. By M. Biett
23. M. Aubergier's Pomatum for
Preventing the Hairs from Fall-
ing Out . - , -
240
ib.
24. Improved Method of Adminis-
tering Epsom Salt. By Dr. James
Henry .... 240
25. On a Preparation of Opium.
By J. C. Boswel!, Esq. - 242
26. Opium used at the General
Hospital, Calcutta. By W. Twin-
ing, Esq. ... - ib.
Practice of Medicine.
27. Sulphate of Quinine and To-
bacco taken as Snuff in the
Treatment of Intermittent Head-
aches. By Dr. D'Huc - 243
28. On the Employment of Chlo-
rine in Pulmonary Affections.
By Dr. Bourgeois ~ - ib.
29. Iodine in Mercurial Salivation.
By Dr. Kluge ... ib.
30. Treatment of Chronic Bron-
chitis. By Dr. Craigie - 244
31. Remarks upon the Nature of
Neuralgias, and their Treat-
ment. By M. Piorry - - 245
32. Efficacy of Madar, (the pow-
dered Bark of the Root of the
Asclepias gigantea,) in Exten-
sive and Obstinate Ulcers in Na-
tive Patients. By J. L. Geddes,
Esq. ----- 249
SURGERT.
33. Extirpation of a Necrosed Cla-
vicle, followed by complete Re-
production of the Bone. By Dr.
Meyer . . - .
34. Reduction of a Double Luxa-
tion of the Inferior Maxillary
Bone, thirty.five days after the
250
occurrence of the Accident, ef-
fected by a New Method of
Treatment. By Dr. Stromeyer
15. Operation for Strangulated In-
guinal Hernia, performed on an
Infant eight days old. By Dr.
Heyfelder . - - -
252
253
xu
C0NTEN1^S»
Page.
36. Lig-ature of the Subclavian Ar-
tery below the Clavicle. By
Professor Blasius - - 253
37. On Sanguineous Tumours of
the Cranium - - . 254
38. Case of Compound Fracture
of the Thigh, in which Amputa-
Page.
tlon was performed. By R. N.
Burnard ... - 255
39. Stricture of the Rectum treat-
ed by the Introduction of a Tent,
by a New Process. By M. Tan-
chou ----- ib.
MlDWIEERT.
40. Malposition of the Spinal Co-
lumn rendering Delivery impos-
sible— Csesarean section — death.
By M. Bello - - - 258
41. New Method for the Division
of the Pelvis in Cases of Diffi-
cult Parturition. By M. Galbiati 259
By Dr.
42. Cesarean Operation,
Tasse . . - -
43. The Advantages of Turning
the Foetus by the Head rather
than by the Feet
44. Luxation of the Pubis during
Delivery. By Dr. Rieke
261
ib.
262
Chemistry.
45. New Method of Preparing Me-
dicinal Prussic Acid. By Richard
Laming, Esq. . _ - 263
46. Test for Hydrocyanic Acid,
and Method of appreciating the
Quantity. By Mr. John T. Barry 264
47. On Cusparia from Angustura
Bark. By M. Saladin - - 266
AMERICAN INTELLIGENCE.
Case of Adhesion of the Placenta
to the Fundus of the Uterus,
successfully treated by Ergot.
By Edward Worrell, M. D. As-
sistant Surgeon U. S. Army.
[Communicated in a letter to
the Elditor]
On the Climate of Florida. By H.
Pemne, M. D. -
Sequel of Dr. Hulse's Case of Un-
united Fracture of the Os Hu-
meri, treated by the Injection of
a Stimulating Fluid into the
Wound - - -
Remarkable Location of Parturient
Pains. By Chandler Bobbins,
M. D. ....
Notes of a Case of Fistulous open-
ing of the Stomach, successfully
treated. By Dr. J. H. Cook
267
270
ib.
271
Observations on the Pathology of
Fever. By John P. Harrison,
M. D. - - - - 271
Professor Dunglison's Address de-
livered to the Graduates of Me-
dicine at the Commencement,
March 19th, 1834 - - 272
The Value of a great Medical Re-
putation, with Suggestions for
its Attainment; a Lecture, Intro-
ductory to the Summer Course
of the Medical Institute. By J.
K. Mitchell, M. D. Lecturer on
Chemistry - - - - ib.
University of Pennsylvania - ib.
Medical Department of the Uni-
versity of Maryland - - ib.
Advertisements - - - 273
THE
AMERICAN JOURNAL
OF THE
MEDICAL SCIENCES.
Art. I. Observations of the Remedial Effects of the Balsam of Co-
paiba in Catarrh and Irritability of the Bladder, and in Leucor-
rhceaf with Cases. By R. La Roche, M. D. of Philadelphia.
vyHRONIC catarrh of the bladder is generally, as every practi-
tioner must be aware of, a dangerous and often a highly painful dis-
ease. In many cases it is of a secondary nature, arising from organic
degeneration of the various coats of the bladder, from the presence of
foreign bodies in the cavity of that viscus, or from diseases of the
annexed organs; while in other instances, the cause of the formation
of the fluid discharged is to be sought for in a chronic irritation of
the mucous follicles or of the substance of the internal lining of the
bladder^ — the sequel of acute inflammation, the effect of a translation
of irritation from some other organ, or the result of the suppression
of a gonorroehal discharge. It is evident that in the former class of
cases, — those in which the disease is secondary or symptomatic, little
benefit can be expected from the employment of means directed
against the chronic irritation — the immediate cause of the increased
secretion; inasmuch as before this morbid state can be corrected, the
remote cause, the original disease, must, if possible, have been removed.
If such means are occasionally found advantageous, they act only as
palliatives. In those instances, however, in which the catarrhal symp-
toms arise from a simple and primary chronic secretory irritation of
the lining membrane of the bladder, and in which the disease assimi-
lates to catarrhal inflammations of other organs, the case is very dif-
ferent, and the object of the practitioner should be to select such re-
medies as are calculated to remove the morbid state in question.
No. XXVII.— May, 1834. 2
14 La Roche on Copaiba in Catarrh of the Bladder^ 8fC.
To present a monograph of catarrh of the bladder — to ofif'er an
account of the symptoms, causes, nature, and treatment of that
disease, might doubtless prove interesting and useful to some of the
readers, and is a task which, though not devoid of difficulty, I should
gladly undertake. But as it would occupy more time and space than
can be conveniently spared on the present occasion 5 and as, in fact,
it is rendered to a certain extent unnecessary by a reference
for valuable information on those subjects, to works of easy access,
I shall abstain from entering into details upon them, and leave
the task to other hands, or postpone it to another and more proper
occasion. The object of the present communication, will be to
lay before the reader some facts in relation to the effects of the bal-
sam of copaiba in the treatment of the disease above-mentioned, and
to show that, if properly administered, and if the cases are carefully
selected, this remedy will be found highly efficacious, as a curative
means, in a large proportion of cases of the primary form of the com-
plaint, and may be prescribed, as a useful palliative, when the symp-
toms arise from a secondary derangement of the affected membrane.
In presenting the results of my experience on this subject, it is very
far from my intention to lay any claim to novelty of practice 5 for I am
fully aware that the balsam of copaiba has long been employed and re-
commended in this disease, and that it is frequently mentioned in va-
rious publications we possess on the diseases of the urinary organs
and on the materia medica, as well as in many periodical works of
the last and of the present centuries. Cartheuser* remarks that
the copaiba is useful in ulceration of the bladder; a condition of tis-
sue which, at the time he wrote, was almost universally thought to
exist whenever there occurred a discharge of mucous or purulent
matter from any part of the body. HoffmanI speaks in high
terms of its effects in the same complaint. At a much later pe-
riod. Dr. StroemJ related a remarkable case of the disease which he
treated successfully by means of the same remedy. The copaiba was
likewise used with complete success by Dr. Bretonneau, of Tours,
in a case of chronic inflammation of the lining coat of the bladder,
brought on by the discharge into that organ of the contents of an ab-
scess situated in the neighbourhood. § Mr. Cumin, in the article Cys-
* Materia Medica.
t Obs. Phy. Chim. p. 24.
% Rapport sur les Travaux de la Societe Medlcale de Suede. BIbliotheque
de Therapeutique, 1. p. 412. Diction, de Mat. Med. 2. art. Copahu.
§ Velpeau — Memoire sur I'Emploi du Baume de Copahu en Lavement. Arch.
Generales de Med. 13, p. 44. Bibliotheque de Therap. 1. p. 389.
La Roche on Copaiba in Catarrh of the Bladder, ^-c, 15
litis, contained in the London Cyclopedia of Practical Medicine,*
remarks that in cases of the disease occurring; in enfeebled consti-
tutions or scrofulous habits, the balsam of copaiba is used with greater
advantage than astringents or the other stimulants of the urinary or-
gans. RiBEst employed it with success in cases of the disease resulting
from suppressed gonorrhcEa. Barrier, of Amiens,:{: and Lalle-
MAND, of Montpellier,§ speak of it as of a useful remedy in catarrh of
the bladder. Chrestien,!| the author of a remarkable work on the la-
traleptic method, prescribed it in combination with turpentine, in small
and repeated doses; and, finally, the late Professor Delpech, of Mont-
pellier,^ remarks that he has succeeded in the most satisfactory manner
in curing, by means of the copaiba, the gonorrhoeal inflammation of the
bladder, evea when the disease was of long standing and had already
assumed a very formidable character. This distinguished writer re-
lates several cases of the kind, and makes the following remarks, which
show the value he attached to this remedy in the treatment of the dis-
ease in question. " Even did we think it proper to renounce the use
of these two remedies, (the bals. copaiba and cubebs,) in order to
combat by ordinary means simple gonorrhoea — a practice which we
are very far from regarding as justifiable, we should not the less per-
severe in the use of them in so serious a complaint, (catarrh of the
bladder,) and thereby prevent the incurable infirmity which is the
least of the evils to be apprehended from it."
The circumstance of the copaiba being spoken of by many physi-
cians of high repute, as a useful and even efficacious remedy in
the disease which forms the topic of these remarks, may perhaps
be regarded by some as sufficient to render further details on the
subject unnecessary. Nevertheless, when it is borne in mind that
by a very experienced practitioner. Dr. Ferrus,** and several other
writers, the remedy is represented as far inferior to turpentine in
that complaint; that by many physicians who have published their
views relative to the treatment of the latter, no mention at all is made
of copaiba; and that it is often neglected in Europe and this country
by those who can have no reasons to fear or doubt its effects, the reader
* Volume 1, p. 505.
t Bulletin de la Society Med. d'Emulation, Sept. 1822, p. 349. Biblioth. de
Therap. 1, p. 359, &c.
^ Mat. Med. 2, p. 120. § Maladies des Voles Urinaires,
II L'HulHier — These sur le Catarrh de la Vessie, Montpellier, 1826, p. 22.
1 Clinique Chirurgicale de Montpellier, 4to. vol. l,p. 271. Revue Medicale^
403. Biblioth. de Therapeutique, 1, 370.
** Diet, de Med. vol. 6, p. 331.
16 La Roche on Copaiba in Catarrh of the Bladder, 8rc.
will at once perceive the propriety of adding such facts to those
already before the public, as appear likely to corroborate what has
been said by preceding and contemporary writers on the subject of
its remedial virtues.
Of the several cases of catarrhal irritation of the bladder in which
I have myself resorted to the copaiba, or seen it used by others, I
shall only offer the details of three, which appear to be sufficiently
interesting to deserve a notice, and well calculated to demonstrate
the efficacy of that remedy.
Case I. — A French gentleman, about sixty years of age, long a
resident of this city, was seized in the year 1822, without any assigna-
ble cause, with acute inflammation of the bladder. By means of an-
tiphlogistic and emollient remedies, which were prescribed by the at-
tending physician, the late Dr. Monges, the most violent and inflam-
matory symptoms were in a few days subdued, and in a short time
the patient was sufficiently relieved to leave his bed and even his
room. Nevertheless, the disease was rather mitigated than effectu-
ally cured. The irritation assumed the chronic form, and was at-
tended with a copious secretion of mucoso-purulent matter, frequent
desire to make water, some difficulty in passing it, and pain at the
neck of the bladder. As, however, the patient suffered much less
than he had done at the commencement of the attack, and as he had
recovered some strength and appetite, he fancied that his com-
plaint was of very slight importance, and completely devoid of dan-
ger, and that it should therefore be left to the powers of nature. In
conformity with these notions, after making use, during a short time, of
appropriate remedies, he positively refused to adhere to any plan of
regimen, or to follow any method of treatment. Of the impropriety
of this course, however, he soon had a distressing proof, for before
a week had elapsed, the pain, difficulty of making water, fre-
quent desire of voiding that fluid, and the other symptoms became
considerably aggravated I in short, the patient experienced a complete
relapse. By a timely application of the means above enumerated,
and which were now prescribed by Dr. Monges and myself, the in-
flammatory symptoms were once more subdued, and the irritation
again assumed the chronic suppurative form. An examination was
now made, which enabled us to ascertain that the prostate gland was
slightly enlarged, but that the urethra was free from obstruction.
The aggravation of the disease, resulting evidently from a total
neglect of the remedial and hygienic means recommended, together
with the pain he experienced, and the large quantity of mucoso-pu-
lent matter voided with the urine, alarmed the patient, and serv-
La Roche on Copaiba in Catarrh of the Bladder, ^"C. 17
ed to open his eyes to the necessity of having recourse seriously to
professional advice, and of submitting to an appropriate treatment.
Antiphlogistics, proportioned to the strength of the pulse and to
the state of the system, were employed with a view to dimi-
nish, or if possible, to subdue entirely the remnant of inflam-
matory action existing in the diseased membrane, and to prepare
the latter for the operation of what have been denominated the
stimulants of the urinary organs; and further, for the purpose
of removing a gastro-intestinal derangement under which the pa-
tient now laboured. These objects being at length attained, and se-
veral remedies having been tried ineffectually to arrest the secretory
irritation of the bladder, the balsam of copaiba was prescribed in mo-
derate doses. Aided by a few others, which were from time to time
employed in order to remove the symptoms of irritation supervening
in the digestive and other organs, and subsequently by moderate ex-
ercise and mild bitters, this remedy succeeded to the fullest extent of
our wishes. Under its use the pain gradually diminished, and, together
with the difficulty and frequent desire to void the urine, finally
disappeared entirely. The secretion of mucoso-purulent matter be-
came less and less copious, and at length ceased completely; the
matter discharged assumed gradually a lighter colour and thinner con-
sistence; and the patient after submitting to treatment during several
months — the use of the copaiba being in the course of that period dis-
continued and resumed several times, to avoid its irritating effects —
had the satisfaction of finding himself completely relieved of the
painful and dangerous disease I have described.
After enjoying good health during about eight years, this gentle-
man experienced another attack of the same complaint, under which
he finally sank. But in respect to the nature of the attack, to the
real condition of the coats of the bladder, or of the prostate gland,
and to the remedies employed, I know nothing, as the case came
under the care of another physician, from whom I have not been able
to obtain any information.
Case II. — The next case I shall mention is that of a gentleman,
aged about sixty-five years, and who, after residing during a consi-
derable portion of his life in Philadelphia, removed to the state of
Ohio. On my way to the south, in 1825, I made a short stay in the
place of his residence, and soon after my arrival was requested to
visit him. I was informed that he had suffered to a greater or less ex-
tent from disease of the bladder during more than two years. He was
much emaciated, and was stretched on a settee, from which he could
with difficulty move, on account of debility. The pain in the blad-
2*
18 La Roche on Copaiba in Catarrh of the Bladder, fyc.
der was very severe, and much aggravated by vv^alking. The desire
to void water was frequent, and the discharge was attended with
some difficulty. Together with the urine, the patient voided a large
quantity of mucoso-purulent matter. The digestive functions were
impaired, the appetite was much diminished, the bowels were con-
stipated, the skin was dry and warm, and the pulse accelerated.
I was at the same time informed by the patient that much dift'er-
ence of opinion had existed among the physicians, who, at various
periods, had attended him, in relation to the nature of his disease, and
to the treatment required for its cure. That some had attributed his
sufferings to a disease of the prostate gland, and had treated him ac-
cordingly; that by others the symptoms were all referred to the ex-
istence of strictures in the urethra, which were endeavoured to be
removed by bougies, caustic, &c.; that besides external and me-
chanical means, a variety of internal remedies had been resorted to,
and that among these the balsam of copaiba had been tried. But
none of these methods of treatment or remedies seemed to have
been serviceable; for the patient declared that so far from having
improved during the time, his complaint had increased and con-
tinued to do so every day.
At the period of my visit he was no longer under the care of a phy-
sician, and had discontinued the use of internal remedies; limiting
himself to the occasional introduction of a catheter to facilitate the
discharge of urine, and to the frequent use of the tepid bath to sooth
the irritation and pain of the bladder. My first impression was
that the disease depended chiefly upon an obstruction at the neck of
the bladder, arising from strictures or from an enlargement of the
prostate gland. This view of the pathology of the case I was led to
adopt, not only from a survey of the symptoms, but from being in-
formed that the patient had, at an early period of life, experienced
several attacks of gonorrhoea, — the usual excitant of the above-mention-
ed complaints, and that, about ten years before, he was seized, while
at sea, with inflammation of the neck of the bladder, attended with
pain, fever, retention of urine, &c. In order to ascertain the fact in
a more positive manner, I passed a bougie, and next a catheter, along
the urethra, but did not experience as much difficulty in penetrating
into the bladder as had been anticipated. By a different examina-
tion, the prostate was found a little larger than in the natural state,
though not sufficiently so to produce an obstruction in the passage;
nor did it appear to be otherwise diseased. To this it may be added,
that the difficulty experienced in making water and the pain attending
this operation, were generally greatly relieved on the passage of a portion
La Roche on Copaiba in Catarrh of the Bladder, Src, 19
of the tenacious matter above-mentioned, which seemed to act as a plug
at the neck of the bladder, and to occasion the greater part of the diffi-
culty. These results very naturally led me to doubt the correctness of
the views already stated, and to conclude that the affections of the
urethra and prostate gland, though sufficiently marked to deserve at-
tention, were not of a character to account for the symptoms, and that
the principal complaint was seated in the bladder itself.
The treatment recommended was based on the above-mentioned
view of the seat and nature of the case. It consisted chiefly of those
means which appeared calculated to remove the chronic inflammation
of the bladder, to diminish the secretion of the mucoso-purulent mat-
ter, and restore the digestive organs to their healthy condition.
Leeches were accordingly directed to be several times applied to the
perinseum and hypogastric region, and, in the event of their not be-
ing procured, cupping to the sacrum was recommended as a substi-
tute- The tepid bath was ordered once or twice a day; emollient injec-
tions and drinks; the occasional use of castor oil, or of any other mild
purgative, to obviate the eSects of constipated bowels; opiates, to pro-
cure sleep, and light nourishment, were likewise enjoined. Finally,
directions were left with the patient to commence the use of the bal-
sam of copaiba in small and repeated doses, in a mild bitter, as soon
as the irritation of the bladder should be somewhat reduced by the
above-mentioned means, and the state of the gastro-intestinal organs
would permit.
The next day I left the place for the south, and on my return,
six weeks after, was informed by a friend who visited me on board
of the steamer, that the gentleman whose disease has just been describ-
ed was probably better, inasmuch as he was now able to walk about
the town. On reaching this city I sought further information from
the patient's friends and learned that he had repeatedly stated in
his letters, that the remedy prescribed by me had had the desired
etfect— that he was comparatively well, and experienced little or
no inconvenience from his painful disease.
This gentleman suffered some time after a severe relapse, and had
recourse to the same means, and with an equally happy result. After
enjoying a tolerable share of health during two or three years, he
again became a sufferer from disease of the bladder; the obstruction
in the urethra increased gradually and at length became almost un-
conquerable, except by mechanical means; the pain became more
and more severe; the discharge of mucus from the bladder in-
creased, was attended with pain, and effected with considerable diffi-
culty. In this condition he removed to Philadelphia, and in the spring
20 La Roche on Copaiba in Catarrh of the Bladder^ ^c.
of 1829, once more placed himself under my care. The usual re-
medies for complaints of that kind were resorted to under the di-
rection of two of the ablest surgeons of the city and myself; but
were not productive of the least amelioration. The patient wasted
away, and after suffering unexampled agony during several months,
sank into the grave. On examination after death, an ill-conditioned
ulcer of the bladder, (in the centre of which was found a small cal-
culus,) was discovered. The prostrate gland was slightly enlarged.
Case III. — In June, 1831, I was requested to visit Mr. R. of
this city, aged about fifty years. He informed me that he had for
some time past suffered considerably from pain in the bladder, par-
ticularly when he endeavoured to retain his urine; that the desire
to void that fluid was very frequent, and that it usually contained
a large quantity of thick whitish matter, which was discharged in
flakes— -principally after the urine itself had been passed, and settled
at the bottom of the recipient. The disease had come on gradually,
and was at first attended with so little pain and inconvenience that
it hardly attracted the attention of the patient, and caused no uneasi-
ness. From this circumstance it was allowed to run on a considera-
ble while before recourse was had to professional advice. Mr. R. had
laboured under a gonorrhoeal attack, which subsided a week or two
prior to the accession of tlie symptoms above-mentioned. At the
period of my visit, the symptoms had become rapidly aggravated, and
the patient was so much indisposed as to be obliged to keep his bed. He
complained, independently of the aflection of the bladder, of gastro-
intestinal derangement, loss of appetite, thirst, slight nausea, consti-
pated bowels, furred tongue, and pain in the head; and had, besides,
a hot skin and a febrile pulse.
Having ascertained by means of a catheter, and by the introduction
of the finger up the rectum, that there existed neither stricture in
the urethra nor enlargement of the prostate, it appeared that the in-
dication was simply to remove the irritation of the mucous coat of
the bladder, and to correct the morbid state of the gastric organs,
on both of which diseases the febrile excitement probably depended.
Leeches were freely applied to the perineum and above the pubes —
emollient injections into the bowels and bladder were ordered,
and the patient was subjected to the routine of remedies, drinks,
&c. usually prescibed under circumstances of the kind. But al-
though adhered to with scrupulous care, this plan of treatment was
not as rapidly beneficial as had been anticipated, and some time
elapsed before decided relief was obtained. As soon as the symp-
toms of acute irritation of the bladder had given way, and the mor-
La Roche on Copaiba in Catarrh of the Bladder, S^c. 21
bid condition of the gastro-intestinal organs and the excited state of the
arterial system had been amended, astringents, tonics and chalybeates,
were successively resorted to, with a view to put a stop to the in-
creased and deranged secretion of the bladder. But none of these
remedies, or the terebinthi nates, were of much avail. Indeed, un-
der the use of some of them, the inflammatory symptoms seemed dis-
posed to return, and it was found necessary not only to discontinue
the use of them, but to have recourse occasionally, to emollient and
even to moderate antiphlogistic means.
The balsam of copaiba was the next remedy tried; but it at first
disagreed with the stomach; laudanum was added, and various ve-
hicles, (among which weak claret and water were found to answer
best,) were tried. At length, however, the medicine was made to sit
well on the stomach, and although administered in small doses, and
discontinued occasionally for a day or two at a time, in order to
guard against gastric irritation, it produced in about two weeks the
most decided benefit. The irritation of the bladder decreased in a
gradual but steady manner — the desire to make water became less
frequent, the discharge of mucus diminished and after a while
ceased entirely; and the patient was at length completely relieved
of the distressing and painful symptoms under which he had so long
laboured.
It is deserving of mention in this place, that during the course of
the treatment, the gonorrhoeal discharge made its appearance, and
continued some days, without, however, occasioning any relief to the
affection of the bladder. It is now nearly three years since this
cure was effected, and the patient has continued free from all un-
easiness about the urinary organs, and in the enjoyment of perfect
health.
It must appear evident to all who peruse these pages, that
the balsam of copaiba was signally useful in the above cases, and
constituted, in fact, the principal means of bringing about the
favourable results I have recorded. Cystitis being always, though
more particularly when it assumes the chronic form, and attacks
persons of advanced age, a protracted and dangerous disease, it
is hardly possible to deny, that the individuals who were the
subjects of those cases, were fortunate in being so speedily — I
speak comparatively— relieved. If this be admitted, we must
allow, also, that the remedy which acted so conspicuous a part in
their cure, is entitled to more commendation than is now usually
bestowed upon it, and should be regarded as a highly useful article in
the treatment of the disease in question. In all the above cases.
22 La Roche on Copaiba in Catarrh of the Bladder, 8rc.
the benefit obtained from the copaiba was, as must have been per-
ceived, not long in manifesting itself j for the first patient was ena-
bled very soon after commencing the use of that remedy to walk out
for exercise; the second had so far recovered in the space of five
weeks as to be able to leave his room, to which he had long been
confined, and to walk about the town; while in the third case, relief
was obtained in a much shorter time than in either of the preceding.
It is not impossible that bj some it may be objected, that those
individuals might have been cured without the aid of the co-
paiba; and that there is no proof of the cure being attributable to
that remedy rather than to the other means employed. In reply, it may
be remarked, that no doubt can be entertained of many cures of chro-
nic catarrh of the bladder being effected without the aid of the copaiba.
To maintain the contrary would be equivalent to representing that
remedy as the only one capable of being of service in that com-
plaint, which would be not only inaccurate, but absurd. It is more-
over highly possible — I will not say certain — that in the very
cases in question, success might have been obtained without it. But
neither of these circumstances appear calculated to detract from the
praise bestowed upon the copaiba, since we have yet to discover the
article of the materia medica so indispensably requisite for the treat-
ment of any disease as not to be dispensed with, with perfect safety
and with a fair chance of success, in many cases. Nor is it less true,
that when we succeed with one remedy in the treatment of a disease,
it is not always easy to prove in a conclusive manner that it is enti-
tled to the honours of the cure. Nevertheless, although there may
sometimes exist room for cavil and disputation on that subject, we
are enabled, by comparing the effects of a remedy in a variety of
cases of the same complaint, with those of other articles, and by
observing the modifications which take place in the symptoms after
their exhibition, to arrive at a tolerably accurate conclusion respect-
ing the degree of the agency of each in occasioning those modifications.
Hence, when an individual who has laboured during some time
under a disease, makes use of a particular remedy, and when
shortly after commencing it, the symptoms begin to yield and
gradually disappear, we may safely conclude, particularly if similar
results have been noticed after the exhibition of the remedy in
other cases of the same complaint, that the benefit obtained is due
to that remedy. The correctness of this conclusion is rendered still
more apparent if the disease belongs to that class, which, when
left to the recuperative powers of the system, are seldom if ever
cured, and if it has been ineffectually combated by other means
La Roche on Copaiba in Catarrh of the Bladder, Sec 23
prior to the employment of the successful one. Now it need hardly
be remarked, that this is precisely what took place in regard to the
copaiba in the cases above described^ for the catarrh of the bladder
is seldom if ever cured without the aid of art; in each instance the
patient had suffered considerably before the remedy was employed^
and in all, the relief obtained follow^ed very closely its exhibition.
With these facts before us it would be scarcely reasonable to enter-
tain any doubt respecting the beneficial agency of the copaiba in the
cases detailed. As the other means employed, at the same time or
shortly before, consisted, except in one case, of antiphlogistics and
emollients, which, so far as my information extends, have never
alone cured a case of suppurative or secretory irritation of the blad-
der, it is not presumable that any other effect can be attributed to
them than that of having moderated the irritation of the organs pri-
marily and secondarily affected, and prevented it from transcending
the degree compatible with the advantageous administration of the
copaiba.
Some difference of opinion prevails among practitioners in respect
to the quantity in which the balsam of copaiba should be administer-
ed to insure it success in the disease which forms the subject of these
remarks. Messrs. Delpech, Ribes, and others, prescribe it in
very large, while other physicians prefer using it in small and re-
peated doses. So far as I am able to pronounce from the facts I have
had occasion to observe, I am disposed to think that the copaiba
answers as beneficial a purpose in the catarrh of the bladder, when
administered in the latter, as in the former dose; and that when thus
given, either in cold water, in milk, or mucilage, or in a slightly aro-
matic infusion, according to the condition of the diseased parts or of
the system at large, there is much less risk of distressing and ir-
ritating the gastro-intestinal organs. Another advantage accru-
ing from that method is, that the physician is thereby enabled to perse-
vere in the use of the copaiba during a much longer period than
when he administers it in drachm and table-spoonful doses; as in the
latter case it is more apt to pass off by the bowels — it is less effectu-
ally absorbed — the system becomes less certainly, as it were, im-
pregnated with it, and less time is afforded for obtaining the desired
effect on the diseased membrane.
It is, I hope, almost a work of supererogation to remark, that
in advocating the use of the copaiba in chronic cystitis, it is far
from my wish to recommend it as an infallible remedy. So far
from this, I am ready to admit that cases occur in which, although
the state of the gastro-intestinal canal, — the degree of irritation in the
24 La Roche on Copaiba in Catarrh of the Bladder, 8,*c,
bladder, and the condition of the arterial system may seem to in-
dicate the probability of success, this remedy fails completely. In
other instances the advantages resulting from its use are of a very
restricted nature^ and in a third set of cases, the symptoms
of irritation are aggravated soon after the remedy begins to pass
off with the urine, although it would have been natural to antici-
pate a very different result. But these cases, particularly the last,
will, I feel confident, prove of rarer occurrence than is imagined.
Even were they more frequent than we know them to be, it would
be impossible to argue from that circumstance the impropriety of
resorting to the copaiba, because the proofs of its efficacy in
many cases are placed beyond the reach of doubt; and on trial it
will be found that its failures are not more numerous than those of
other remedies which are in daily use in the hands of many physi-
cians. Indeed it is impossible to point out any article of the materia
medica which succeeds invariably, and is not apt to fail or sometimes
to act injuriously under particular circumstances. If therefore, we
abandon the use of the copaiba on the strength of its sometimes fail-
ing, or of its producing undue irritation, there is no reason why we
should continue to employ other articles just as uncertain as it in
their effects. Impressed with the correctness of this circumstance,
and relying on what I have had occasion to observe myself, as well
as on the favourable testimony borne as regards its effects in the vari-
ous publications cited above, I feel no hesitation in affirming,
that whatever may be its want of success in some cases, the
copaiba deserves a trial in the disease before us; that in a few
weeks, sometimes in a shorter period, — -provided the cases be well
selected, the symptoms of acute inflammation properly subdued, and
the stomach be free from irritation, the pain in the bladder will
begin to subside, the flow of urine will become freer, and the de-
sire to void it less frequent, and the quantity of matter will de-
crease in a very sensible manner. In some instances the copaiba,
after producing a marked amelioration of the most urgent symptoms,
loses its effect. It often becomes necessary under such circum-
stances to discontinue it entirely and to resort to other remedies; but
in some instances it will be sufficient to suspend its employment
during a few days. Indeed from some facts which have presented
themselves to my observation, I am inclined to believe that when-
ever we resort to the copaiba in affections of the mucous lining of
the bladder, it is more advantageous to continue it only during
a limited period — from a few days to one or two weeks; and to re-
sume its use after a short interval. This plan I have pursued even
La Roche on Copaiba in Catarrh of the Bladder, Src, 25
in cases in which there was no evidence of diminished virtue in the
remedy; the object being to prevent the membrane from becoming
habituated to its action, or unduly irritated by it, and also to guard
against the inflammation or derangement of the stomach, which it is
sometimes apt to occasion.
That those who resort to the copaiba in catarrhal affections of the
bladder may not be precipitate in abandoning it, when it does not
prove promptly effective, we may observe that cases present them-
selves in which this remedy is very slow in its effects, and that in
one or two instances in the practice of a friend, in which the re-
medy was ultimately successful, several weeks elapsed before any
decided amendment was obtained. Had it been discontinued at an
early period, it might have been accused of failure; but the issue
showed how erroneous such a conclusion would have been, and proved
the necessity of giving the remedy a fair trial in all cases. It
is not unlikely that some physicians may exclaim that a remedy which
is sometimes so tardy in its operation, does not deserve the attention
here bestowed upon it, and should make way for others of a more
prompt efficacy. This objection, however, need not occupy our atten-
tion very seriously, because the cases in which the curative effects of the
copaiba are slow in being obtained will be found of comparatively rare
occurrence, and because it is doubtful whether the other remedies re-
commended in the same complaint would really act more expeditiously.
The disease has always, and with reason too, been regarded as one of a
very formidable character, and little under the controul of the most ra-
tional plans of treatment and of the most approved remedies, and there is
not one of these with which I am acquainted that is not occasion-
ally as slow in its operation as the copaiba is found to be in some in-
stances.
The above cases and remarks will, it is hoped, tend to show that
the balsam of copaiba may, under particular circumstances, be ad-
vantageously used in the treatment of catarrhal inflammation of the
bladder; that it is not necessary to prescribe it in very large doses;
that it may be useful when the diseased parts are yet in a state of
well-marked irritation; and that it is not simply useful by putting
a stop, by its astringent qualities, to the copious discharge of matter
resulting from a relaxed state of the mucous membrane. At the same
time, they show that the copaiba is not an infallible remedy; that in
some cases it fails completely; that in others it is very slow in pro-
ducing its remedial effects; that in a few instances it may even be in-
jurious; but that if due care be taken in the selection of the proper
cases, and if the diseased parts be well prepared for its administra-
No. XXVII.— May, 18S4. 3
26 La Roche on Copaiba in Catarrh of the Bladder, 6,^c.
tion, and the gastric organs in a proper condition, it will seldom
give rise to those effects, and will act both safely and expeditiously.
Irritability of the Bladder. — From what has been stated in the
course of the preceding remarks, it may perhaps be inferred, that in
the opinion of the writer, the ujje of the copaiba should be restricted
to those cases of diseases of the bladder, in which the mucous mem-
brane is affected with a secretory or suppurative inflammation. Such,
indeed, was long the sentiment he entertained on the subject, and
to which he was led by the silence of writers in relation to the effi-
cacy of that remedy in cases of a different character; by a considera-
tion of its known astringent and stimulant properties, and by the
want of opportunities to test its virtue in other than secretory inflam-
mations. Subsequent experience, has, however, taught him the
propriety of changing his former views, for in a few cases present-
ing evident symptoms of chronic irritation of the mucous mem-
brane of the bladder, but unaccompanied by increased morbid secre-
tion, he has prescribed the copaiba with the most decided success.
These results prove, in a most conclusive manner, that the copaiba
does not act, in affections of the mucous membranes, simply by arrest-
ing a profuse secretion, the effect of an atonic state, but that it
operates, in certain diseases of those parts, either by virtue of a spe-
cific action, or by revulsion. But whatever be the conclusion to
which we may arrive from these facts, respecting the mode of
operation of the copaiba, they show that the remedy may be used in
a set of cases in which, so far as my information extends, it has not
often been employed. Nevertheless, while expressing these senti-
ments, it is far from my intention to suggest the propriety of resort-
ing to the remedy in question in all cases of chronic irritation of the
bladder. My opportunities of using it in that disease have been too
limited to justify so indiscriminate a recommendation; and while I
am inclined to think, from the trials I have made, that the copaiba
will prove serviceable in some instances, 1 can easily comprehend
that it should not be used without great caution.
The following case will, it is believed, justify the praise thus be-
stowed upon it.
Case. — Mr. G. aged about forty-five years, and of a nervoso-san-
guine temperament, applied to me for professional advice, in the au-
tumn of 1826. He informed me that he had, for a long while prior
to the onset of his present malady, enjoyed excellent health, — that,
without being able to assign any cause, he had in a very gradual man-
ner become affected with irritability of the bladder; and that this com-
La Roche on Copaiba in Catarrh of the Bladder, fyc. 27
plaint, which proved the source of much inconvenience and considerable
uneasiness to him, was characterized bj very frequent desire to make
water, and by pain whenever he endeavoured to retain it. As Mr.
G. was, by the duties of his profession, — that of a teacher of music,
under the necessity of remaining, often during an hour or two at a
time, in attendance on ladies, and could not in consequence absent
himself as frequently and as promptly as might be required to satisfy
the calls to make water, he was at times placed in a very embarrassing
predicament, and on several occasions was unable to get off with
sufficient celerity to escape an unpleasant accident. Owing to these
circumstances, and to the frequency of his disturbances at night,
he expressed the greatest desire to place himself at once under me-
dical treatment, and regretted his having lost much time in trying
a variety of remedies recommended to him by officious friends. He
informed me that he had experienced, a few years before, several at-
tacks of gonorrhoea, which, however, appeared to have been entirely
cured. He further stated that his genital organs were easily excited,
that he was much prone to certain desires, and that he was not back-
ward in gratifying them. With the exception of the vesical irrita-
tion above-mentioned, and which was unaccompanied by a discharge
of mucus, or by a gravelly deposit in the urine, Mr. G. was free from
any disease of importance. He complained only of slight gastric
derangement, and on examination the temperature of the surface and
the pulse were discovered not to exceed the standard of health.
It appeared evident, from a survey of the symptoms under which
Mr. G. laboured, that his disease could not depend merely on the ir-
ritating quality of the urine,—a cause assigned by some writers to cases
of the kind, because the disease had already lasted some time, and
had continued uninfluenced by any of the articles of food or drink
made use of, and because the fluid was in general pale, and always
limpid. Nor did it seem at all likely, from this condition of the urine,
as well as from the absence of pain in the bladder after voiding it,
that the complaint depended on gravel or stone. Finally, the power
of retaining the fluid, though at the expense of a little suffering, in-
dicated that the symptoms could not be the result of an atonic or de-
bilitated state of the muscular coat, or of the sphincters of the blad-
der. The only view of the case, then, that appeared to be well found-
ed, was that the disease — for so the complaint under which Mr. G.
laboured, and which almost amounted to incontinence of urine, de-
served to be called — arose from an irritation of the lining membrane
of the bladder, which irritation was aggravated by the presence of the
urine, and acting secondarily on the muscular coat elicited its con^
28 La Roche on Copaiba in Catarrh of the Bladder, ^c.
traction in order to effect the expulsion of the offending cause. Under
the influence of this opinion, recourse was had to such means as might
prove serviceable in removing and in guarding against the occurrence
of circumstances capable of keeping up the morbid state in question.
The patient was advised to abstain from sexual intercourse, and from
all circumstances capable of arousing the excitability of the genital
organs. Remedies calculated to restore the functions of the gastro-
intestinal canal to the healthy point were prescribed, and to these
were added, for the purpose of removing the affection of the bladder,
moderate antiphlogistic, demulcent, narcotic, and antispasmodic
means, both general and local. These remedies were persevered
in during a considerable time, but proved of no avail. Recourse
was next had to uva ursi, to the tincture of cantharides, to nux vo-
mica, to muriated tincture of iron, &c. under the impression that the
disease, after all, might depend on a different cause from that which
had at first been assigned. But, instead of having the desired effect,
these remedies appeared to aggravate the disease, and my patience,
as well as that of Mr. G. was becoming exhausted, when it occurred
to me that the balsam of copaiba might perhaps be employed bene-
ficially. To this I was led, not by the result of any previous per-
sonal experience with this article in cases of the kind, or by having
seen it recommended by other practitioners, but by the recollection
of the decided benefit obtained from it in chronic secretory irri-
tation of the mucous membranes generally, and by reflecting that
as the remedy probably produces its ettects through means of a pecu-
liar action exercised on that tissue, and not merely through its
astringent properties, it might display a beneficial effect in the case
before me, although the irritation was not accompanied by increased
or morbid secretion. In conformity with this view, the copaiba was
prescribed in doses of thirty drops, three times a day, and, to the no
small satisfaction of the patient, the disease began, in a very short
time, to give way. The calls to make water became gradually less
frequent, the pain diminished, Mr. G. was soon enabled to retain his
urine much longer than he had done for a considerable period before,
and in the course of a few weeks he was completely freed from his
troublesome and painful complaint. He continued the use of the co-
paiba, as a precautionary measure, during several weeks longer, and
left it off gradually.
Another case similar to the one just described has since fallen
under my observation. The copaiba was used in the same man-
ner, and proved equally, and indeed more rapidly, successful. But
as the details would occupy more space than can be spared, and
La Roche on Copaiba in Catarrh of the Bladder^ ^c, 29
prove of little interest to the reader, I shall abstain from present-
ing them.
Since writing these pages, mj friend. Dr. Hays, to whom I com-
municated the above facts, has tried the copaiba in a case of irrita-
bility of the bladder, which had resisted the usual remedies, and ob-
tained from it results as satisfactory as those I have recorded.
The balsam of copaiba has been used in other diseases of the uri-
nary organs. Boerhaave, (Aph. 1001,) recommends for the cure of
abscess of the kidneys, after the urine becomes purulent, simple diu-
retics in soft and nitrous spa waters, together with the whey of new
milk, balsams^ and the like^ and Van Swieten, in commenting on
this Aphorism, speaks in terms of commendation of the above prac-
tice, and remarks, in relation to the balsams, under which name he
includes only the natural ones, the Peruvian, the copaiba, &c. that
they have their merits in such ulcerations of the kidneys, if they are
given in small doses, three or four times a day, with plenty of dilu-
ents drinks. Otherwise, he adds, they are over-heating, and will
often cause strangury and inflammation of the urinary passages. At
a much more recent period, Nysten* stated that the balsam of copaiba
is occasionally found useful in cases of nephritic calculi, and we
learn from Mr. BRANDEt that he has seen it of service in allaying the
irritation and diminishing the secretion of red or uric sand. Mr.
Hooper, in his account of the sick landed from Corunna,:]; states that
he employed the copaiba with immediate relief to those patients who
complained of a suppression of urine; the disease under which they
laboured being the dysentery. The medicine appeared to be of ser-
vice in relieving the tenesmus, "and a small quantity of urine was eva=
cuated soon after the administration of the second dose." It is likely
that in all those cases the copaiba was serviceable partly from its
effects as a diuretic; but in those instances in which Mr. Hooper
found it useful, the benefit may in some measure be ascribed to the
soothing effects of the remedy on the irritated mucous membrane of
the intestines, the inflammation and pain of which probably served
to keep the urinary organs in a state of vital orgasm, and thereby
prevent the secretion or the discharge of the urine from taking place.
In a communication read before the Philadelphia College of Phy-
sicians a few years ago, and which was published in the North Ame-
rican Medical and Surgical Journal, vol. 6, Dr. John Ruan, of this
city, related several cases of a distressing disease, the pruritus vulvas.
* Diet, des Sciences M^d. art. Copahu. f Manual of Phajjnacy. p. 17.
* Edinburgh Medical and Surgical Journal, vol, 5, p, 400,
3*
30 La Roche on Copaiba in Catarrh of the Bladder, ^c.
In the first case many remedies were employed. Some of these pro-
cured some mitigation to the patient's sufferings, but nothing like a
cure was effected until the balsam of copaiba was used. This, in
doses of twenty drops, three times a day, acted like a charm. In a
second case, a variety of remedies were ineffectually used. The co-
paiba was at length resorted to, and proved speedily successful. Dr.
Ruan tried the same remedy in two other cases, but it failed. When,
however, we bear in mind the distressing character of the pruritus
vulvae, and its unmanageableness with the remedies ordinarily em-
ployed for its cure, we cannot help being gratified at the results ob-
tained by Dr. Kuan with the copaiba. Two cases out of four do not
constitute a trifling proportion, and the success must necessarily en-
courage us to make further trials with that remedy. I have myself
had no experience with it in this disease, or in any of those mention-
ed above, and have only alluded to the subject for the purpose of
completing the survey of the principal affections of the urinary organs
in which the copaiba has been found serviceable.
Leucorrhoea. — The introduction of the balsam of copaiba in the
treatment of leucorrhoea may be traced to a very remote period in
the history of that article, for on consulting the various writers who,
in the preceding and present centuries, have entered more or less in
detail on its medicinal virtues generally, or spoken of it in reference
to its effects in particular complaints, it will be found that it is often
represented as a useful remedy in that disease. Ettmuller, and
some other of the older physicians, recommended terebinthinate and
balsamic medicines in the treatment of leucorrhoea, and although they
do not make special mention of the copaiba, we may presume that
they allude to it no less than to the other remedies of the same class.
We find also that so early as the year 1710, Hoppe, in a disserta-
tion on the medicinal virtues of the article,* speaks of its use in
that disease in a manner calculated to show that in his times it consti-
tuted a favourite remedy. Lewis! enumerates leucorrhoea among
the diseases in which the copaiba is principally used, and in which it
is found preferable to the other balsams. Motherby± and Lieutaud§
also mention it as a valuable remedy in the same complaint. If we
pass to writers of a more recent period, we shall find, that although
the remark of Dr. Cullen, who for a time was considered as high
* See CuUen's Materia Medica, vol. 2, p. 134, Barton's edition,
t Materia Medica, 4to. p. 132. ^ Medical Diet. p. 200.
§ Matiere Medicale, 1. 321.
La Roche on Copaiba in Catarrh of the Bladder, fyc, 31
authority in practical medicine, that it is not often prescribed
with success, <' owing to the stomach not being able to bear a suffi-
cient quantity of it,"* deterred many from resorting to it, yet the
number of its advocates has been, since the time of that illustrious
professor, nearly as great as it was formerly. It is mentioned with
more or less commendation by Dejaen,! Cattet and Lacombe,J
Barbier,§ Armstrong,1| Fabre,^ Larrey, of Toulouse,**
GooDjtt Montegre,^: Richard,§§ Nysten,||1| Locock,^^ Merat
and Delens,*** and by some of these writers it has been frequently
used with the happiest results, and recommended as an invaluable me-
dicine in particular stages of the disease in question.
But although the copaiba has long been used and continues to be
enumerated among the most useful remedies in the treatment of leu-
corrhoea, some difterence of opinion prevails in relation to the form
and stage of the disease to which it is more particularly appropriate.
Some practitioners, for example, have resorted to it, and seem dis-
posed to advocate its employment, at an early period | even when there
still exists considerable activity in the capillary circulation of the dis-
eased part, as manifested by pain, heat, and the dark colour and vis-
cid nature of the matter discharged. Others, on the contrary, main-
tain that it should be carefully abstained from under such circum-
stances, and that it is only useful or safe in recent and sim-
ple cases, when there exists from the commencement an atonic
state of the parts, or else in the last stages of the inflammatory
form, when the increased action in the affected membrane has been
completely subdued by antiphlogistics; in a word, when the com-
plaint has passed to the chronic state, and the discharge is kept up by
a sort of vitiated habit.
It need hardly be remarked that in this country, where the copaiba
is more generally and extensively employed in the treatment of ure-
thral discharges than any where else, the number of physicians who re-
sort to it to combat leucorrhoea — between which and the complaints
just named there has generally been supposed to exist considerable
* Materia Medica, 1. 134. f Diet, des Sciences M^dicale, 6. art. Copahu,
^ Bibliotheque Med. 35. p. 202. § Matiere Medicale, 2. p. 120.
II Practical Illustr. of the Scarlet Fever, &c. p 359.
t De la Sophistication des Subst. Medicinales, p. 18.
** Annales Cliniques de Montpellier, 26. p. 292.
ft Study of Medicine, 5. p. 71, (American edition.)
++ Traite des Hemorrhoides, p. 351. §§ Elemens d'Hist. Nat. 2. p. 507.
nil Diet, des Sciences Med. 6 . If Cyclopedia of Pract. Med. 3.
•♦* Diet, de Matiere M^d. 2. p. 418.
32 La Roche on Copaiba in Catarrh of the Bladder, fyc.
analogy, is comparatively small. Such being the case, it is not likely we
shall discover many among them capable of furnishing from the result of
their own experience such information as may enable us to arrive at a de-
cision in respect to the points above-mentioned, and from whose writings
any knowledge of a valuable character relative to the use of copaiba
in leucorrhoea can be obtained. Influenced, however, by a considera-
tion of the effects obtained from that remedy, not only in gonorrhoeal
discharges, but in the secretory irritation of the mucous membranes
generally, as well as by the opinions expressed and the facts detailed
by the writers whose names are recorded above; little satisfied, be-
sides, with the effects produced in some cases by the articles usually
resorted to in the treatment of fluor albus, I ventured, notwith-
standing the silence of our writers on the subject, to make use
of the copaiba in two cases which had resisted the usual plans
and the most vaunted remedies. The results were such as to en-
courage me to make further trials with it myself, and to urge the
propriety of doing the same on some of my medical friends. This
was accordingly done, and on comparing my own notes and those fur-
nished to me on the cases treated by the copaiba, and on reflecting
carefully on the eff*ects obtained, I have no hesitation in recommend-
ing it as a useful remedy in the treatment of leucorrhoea, and in expres-
sing the opinion that it is more efficient than some others much more
loudly extolled by writers in Europe and this country; that when used
in suitable cases, and with proper precautions, it will be found to be
a perfectly safe article; and that it possesses an advantage over cer-
tain remedies, in greater vogue, of never or very seldom giving rise
to strangury and other painful accidents, which render those articles
so objectionable to all patients, and to unprejudiced practitioners.
In saying thus much of the efficacy of the copaiba in leucorrhoea,
it is not my wish to represent it as capable of being successfully em-
ployed in all cases and under all circumstances, or as being superior
to all the other remedies usually prescribed in that disease. Cases have
presented themselves in which it has been productive of little bene
fit, or has even failed completely. To claim for it a power over all
cases, and beneficial effects in every stage of the disease, would be
not only to present an exaggerated estimate of its real efficacy, but
also to betray an unpardonable ignorance respecting the diversity of
circumstances connected with the production of leucorrhoeal dis-
charges, the degree of safety attending their suppression, and the
variety of morbid conditions on which they may depend; as well as
respecting the known properties of the remedy, and the difference of
effects produced under different, and even under analogous circum-
La Roche on Copaiba in Catarrh of the Bladder, fyc. 33
stances in the same complaint, by the same medicinal agents. Every-
one knows that leucorrhoea is often a symptomatic complaint, the state
of the general habit being the cause of it, the fons et origo malL
In such cases, the suppression or diminution of the discharge by the
copaiba or other means, may doubtless be desirable and advantageous;
because independently of the fact, that it is loathsome to the patient,
this discharge tends in its turn to keep up that deranged state of the
constitution on which it depends. But in all such cases this suppression
can only be of secondary importance; the constitutional derangement
claiming, of course, the principal share of attention. In another set of
cases leucorrhoea depends on, and is symptomatic of an affection of
the uterus or of some other organ; and before the discharge can be
removed, the disease giving rise to it must be eradicated. Here
again the copaiba and other anti-leucorrhoeal remedies can only be
of secondary advantage; and very many cases will occur in which it
cannot be used at all, or will prove far inferior to other means.
In a third series the organs w^hich receive the first impression of the
copaiba are so implicated as to require our prohibiting altogether the
use of the remedy; although the disease itself, might, under different
circumstances have been benefited by it. In a fourth set the discharge
has assumed the character of an habitual drain, which it would be
dangerous to suppress, unless we establish a substitute in some other
part of the body, and which, indeed, it is often found impossible to
put a stop to by any of the remedies in our possession.
But after making a deduction of the cases of the above descrip-
tion, in all of which, by the way, cantharides and other remedies so
pompously recommended would prove just as objectionable as the
copaiba, there will remain a number of others, depending on causes
of a very different kind, and connected with a different condi-
tion of the system at large, or of the gastro-intestinal organs in par-
ticular; in a word, which are local in their character; free from com-
plications contraindicating the use of active anti-leucorrhoeal reme-
dies, and which it may be possible and desirable to cure. It is in
such cases that the balsam of copaiba will, unless I am greatly mis-
taken, prove often useful. If other means are sometimes found to
succeed in cases in which the copaiba has failed, the circumstances
must be attributed to a particular idiosyncrasy in the patient, to a
peculiar degree and kind of irritability of the gastric mucous mem-
brane, either natural or acquired, by which it is rendered incapable
of bearing the contact of that remedy, or to other causes, need-
less for me to enumerate. But be the cause what it may, it is not
possible to discover in those failures a reason for refusing to employ
34 La Roche on Copaiba in Catarrh of the Bladder, S^'C.
the copaiba, inasmuch as on trial it will be found that the cases in
which it proves inefficacious are of rare occurrence; and because, as
every physician must know, a similar objection might, with equal
justice, be urged against every article of the materia medica.
The nature of the action exercised by the copaiba on the living
tissues, and its mode of operation in disease would seem to indicate,
a priori, the necessity of deferring the employment of that remedy,
in leucorrhoea, until the imflammatory symptoms — heat, pain, febrile
excitement, and dark colour of the matter discharged, — had been, to a
certain degree, subdued by antiphlogistics and emollients. Now,
experience will, I feel confident, be found fully to justify the suppo-
sition; and no one who has used the copaiba to some extent in the
disease in question, and marked its effects, will refuse to join in the
sentiment that the practitioner, whenever he wishes to derive benefit
from it, must carefully conform to the plan suggested. On this point
it is necessary to be very explicit; because there are some physicians
who, while admitting the inflammatory nature of leucorrhoea, dis-
regard the necessity of depletion; and who, viewing the copaiba in
the light of a specific, might feel disposed to use it in all the stages
of the disease. Again, on the other hand, there are not wanting
works, of some authority too, in which leucorrhoea is represented as
being, in every case, and under all circumstances, — whatever symp-
toms present themselves, a disease of debility, depending on a re-
laxed or atonic state of the parts and of the system at large, and
calling from the commencement, for the use of tonics and stimu-
lants, among which are properly placed the balsamics. It need hardly
be remarked to those who entertain different views of the nature of
the disease, as well as of the remedies required for its cure, and of
their mode of operation, that the opinions alluded to are calcu-
lated to lead to an erroneous and dangerous practice. They will
immediately perceive the propriety of insisting on the necessity of pur-
suing the course I have recommended, — of resorting to antiphlogistics
in the early stages, whenever the inflammatory symptoms run high,
and abstaining from copaiba until these have been greatly moderated —
and thereby preventing, if possible, others from adopting the mode
of practice advocated by the physicians and in the works adverted
to. It is necessary to add, that, in order that the copaiba may be
used with effect and safety, in leucorrhoea and other complaints of
the mucous membranes, all symptoms of gastric inflammation or ir-
ritation should have subsided.
But while thus dwelling on the necessity of subduing, by proper
remedies, symptoms of undue irritation previously to administering
La Roche on Copaiba in Catarrh of the Bladder, <^c. 35
the copaiba, I am far from admitting the propriety of limiting its
use, as Lagneau, Pinel, Bricheteau have recommended, to those
cases in which there really exists an atony of the diseased organs, and
to the very last stage of the complaint, when nothing seems requi-
site to be done but to give tone to the parts and to arrest the dis-
charge. This would be going to another extreme, which may with
propriety be regarded just as unfounded as the one already no-
ticed. So far, indeed, from pointing out the necessity of restricting
so greatly the use of the copaiba, experience teaches that it may be
usefully employed in cases in which, though the inflammation has been
considerably moderated by antiphlogistics and soothing applications,
the parts are not only in a state different from atony, but present pheno-
mena characteristic of a notable degree of irritation. That such is
the state of the diseased tissue in many cases in which the copaiba is
usefully employed, we have a proof in the circumstance, that with
few exceptions, other stimulants are generally not only useless but
detrimental.
But enough has already been said on this subject, and after re-
marking, that the fact of copaiba being useful under the circum-
stances mentioned, shows that the object to be obtained is not
simply to astringe and strengthen an atonic tissue, but to produce an
action capable of modifying and thereby removing the morbid one
on which the disease depends, I proceed to present the details of a
few cases which, it is believed, will serve to confirm the views I
have thus advocated.
Case I. — A married coloured women, about thirty years of age,
and of a lymphatic temperament, consulted me a few years ago for
well-marked leucorrhoea. The disease was of two months standing,
and proved a source of great inconvenience to her on account of the
profuseness of the vaginal discharge, of the sensation of heat, and
of the pain she experienced in the parts, particularly during coition.
The matter was thick and of a dark colour^ the skin was rather
warmer and drier than in the natural state; the pulse quick and
tense; and the tongue red on the edges, and furred in the centre. There
was little or no appetite for food, and the bowels were constipated.
On examination per vaginam, the parts were found to be tender,
but the uterus exhibited no signs of disease. The patient informed
me that she had menstruated at the regular period, two weeks before,
but that on that occasion, as well indeed as ever since the appearance
of the leucorrhoeal complaint, the quantity of blood discharged was
much smaller than it was in ordinary times. It may be added, that
her health was naturally delicate; that she had some years before
36 La Roche on Copaiba in Catarrh of the Bladder, 4*c.
laboured under a protracted attack of the same disease^ that she had
taken a vast quantity of medicine for its cure, and finally, that her
habits of life were correct and temperate.
In order to subdue the vaginal irritation and the gastro-intestinal
derangement, bleeding from the arm, emollient drinks and lavements,
vaginal injections of the same nature, tepid baths, low vegetable
diet, and complete abstinence from sexual intercourse, were recom-
mended. In less than a week the woman again called to see me.
Finding now that the gastro-enteritic irritation had greatly abated,
and that the other symptoms were somewhat mitigated, mild purga-
tives were ordered, and the patient was advised to continue the use
of the above-mentioned means — venesection excepted. At the next
visit the pulse was found to have lost its tenseness; the tongue pre-
sented a more natural appearance; the appetite had improved; the heat
and pain in the vagina had lessened, and the matter discharged, though
still abundant, had lost to a certain degree its viscidity and dark
colour.
Regarding this as a suitable case for the exhibition of the copaiba,
twenty-five drops of the medicine were prescribed three times a day
in a wine glassful of milk. The patient was desired to continue, if
possible, the use of the copaiba during two weeks without intermis-
sion, and to call on me at the expiration of that time. This was
faithfully complied with, and when next I saw her, she informed me
that the remedy did not in the least disagree with her stomach, that
since she commenced using it the leucorrhoeal discharge had greatly
decreased, and that in every respect her health was much improved.
The copaiba was ordered to be continued in increased doses, and in
a short time the woman called on me, and reported herself perfectly
restored and free from her troublesome complaint.
It may be remarked, that in this case no astringent, tonic, or sti-
mulant, no anti-leucorrhoeal remedy, except the copaiba, was pre-
scribed, and that the latter was resorted to, although the parts were
far from being in a state of atony. From these circumstance-^, and
owing to the fact, that a cure could not have been effected by the
means at first prescribed — antiphiogistics and emollients, it must
follow, that the entire credit should be awarded to the copaiba, and
that those who would limit the use of this remedy to atonic cases,
have but a very imperfect idea of its efficacy and mode of operation.
The attack just described, though, as appeared from the information
communicated by the patient, more formidable than the one under
which she had laboured formerly, was cured much more expedi-
tiously; from which we may conclude, that the copaiba is, at least
La Roche on Copaiba in Catarrh of the JBladder, S^c. 37
sometimes superior to other anti-leucorrhoeal remedies. Whether
this woman has continued free from the disease since that period, I
am unable to say, as I have completely lost sight of her.
Case II. — Madame B. aged about forty years, of a nervoso-san-
guine temperament, and usually enjoying good health, experienced
about the year 18£6 domestic troubles, which brought on a state of
melancholy. The catamenial functions were deranged, both in
respect to the quantity of blood discharged, and to the regularity of
the periods. The digestive functions became in a short time impli-
cated, to such a degree indeed, that the gastric derangement assumed
at length the characters of well-marked dyspepsia. A short time
after the commencement of her disease, Mrs. B. was attacked with
acute pain in the region of the bladder attended with frequent desire
to make water, and with copious leucorrhoeal discharge.
Such was the state of Mrs. B. when I began my attendance. As
may readily be presumed, the first remedial measures resorted to
were such as appeared best calculated to relieve her from the pain she
suffered, and to restore her digestive and urinary organs to their
normal condition. Leeches, rest, hip-baths, emollient vaginal in-
jections, fomentations, opiates, a suitable diet, were successively
prescribed. By these means the irritation of the bladder was soon
relieved, but the dyspeptic symptoms which evidently depended
more on gastralgia than gastritis, continued unabated. With a view
to remove them, a variety of remedies ordinarily used in such cases
were administered, but without success. The prussic acid was now
prescribed in small doses, and proved so highly and promptly effica-
cious, that in a short time the gastric derangement disappeared com-
pletely. This desirable object having been attained, an opportunity was
afforded for administering such remedies as appeared required to put
a stop to the leucorrhoeal discharge, which had been little, if at all,
influenced by the treatment heretofore pursued, and was accompanied
with heat and pain in the vagina.
After continuing the use of emollients a few days longer, I ven-
tured, not without hesitation however, on a few drops of copaiba,
and directed that the remedy should be taken in a small quantity of
milk, and on a full stomach. But as this organ, though free from positive
disease, was preternaturally irritable, some difficulty was at first ex-
perienced in causing the copaiba to sit well upon it. Pain, nausea,
and occasional vomiting, were the consequence of its use, and neces-
sitated the suspension of it. At length this condition of the stomach
being relieved by proper means, another trial of the copaiba was
determined upon, v/hich proved more successful than the first.
No. XXVII.— May, 1834. 4
38 La Roclie on Copaiba in, Catarrh of the Bladder, ^c.
the remedj agreeing better than it had dor^e before, and pro-
ducing none of the effects mentioned above, with the exception
of a little nausea. The dose was in consequence gradually in-
creased to twenty-five drops three times a day. For fear how-
ever of its once more occasioning, if persevered in constantly,
imdue irritation of the stomach, it was discontinued for one day at
a time, twice a week, and the patient was directed to make use, on
those days, of emollient drinks, and small doses of prussic acid. By
attending to these precautionary measures, Mrs. B. was enabled to
continue the use of the copaiba in the quantity stated during a month,
at the expiration of which she was almost entirely relieved of her
leucorrhoeal complaint. The medicine was, in consequence, gra-
dually discontinued; and slightly astringent vaginal injections and
washes were made use of. In a short time the menses returned;
her mental depression disappeared, with the domestic troubles which
had given rise to it; the digestive functions were restored, and Mrs.
B.'s health became completely reestablished.
The case I have just described affords an example of a very serious
derangement of health occasioned by mental depression, as well as
of the beneficial effects of the prussic acid in gastralgia. But what
is more to our present purposes, it exhibits the advantages that may
be derived from the administration, with suitable precautions, of
the balsam of copaiba in leucorrhoea. It may perhaps be ob-
jected, that the cure was protracted beyond the usual limits,
and that this circumstance detracts somewhat from the credit
I have awarded to the copaiba. But if we bear in mind the com-
plicated nature of the disease in this instance, and the difficulty
usually experienced in putting a stop to fluor albus — whatever
be the remedy employed, the objection must be found to lose
much of its force. For my part, I think it probable that in the
instance before us, no other article would have proved more ra-
pidly serviceable; and certain it is, that in consequence of the im-
paired state of the stomach, and the irritation which had existed at the
neck of the bladder, several of the more popular remedies for leucor-
rhoea would have been completely inadmissible. It is also probable, that
if the copaiba had been prescribed before the removal of the gastral-
gia, it would have acted very injuriously, or at least sufficiently so
to necessitate its being laid aside altogether, for its action, as has
been stated, is of a stimulating nature, and it cannot, on this account,
be regarded as free from detrimental effects so long as the stomach
remains in a state of morbid excitement. The truth of this remark
will be rendered evident by the details of the following. case.
La Roche on Copaiba in Catarrh of the Bladder, Sec. 39
Case III. — In October, 1825, I was requested to attend Mrs. B. a
native of New Orleans, who was labouring under an attack of mea-
sles. This lady was about twenty years of age; had been two years
married; had not borne children, and was generally regular in her
catamenial functions. Her husband informed me, that she had been
affected with leucorrhoea during the last eighteen months — that this
disease had come on in a gradual manner, and had been treated un-
successfully by means of cold bath, Peruvian bark, and other reme-
-dies of the same kind.
Having been consulted by Mrs. B. solely for the exanthematic
'disease, my attention was directed exclusively to this complaint,
from which my patient recovered in the usual period without having
experienced any untoward accident, except a copious uterine haemor-
rhage which supervened on the fourth day of my attendance: I after-
wards lost sight of Mrs. B. for more than a year. At the expiration
of this period, her husband called on me, and stated, that on the re-
commendation of some officious friend, his wife had consulted an
-elderly German physician, then a resident of this city, concerning
her leucorrhoeal complaint; that this physician had at first prescribed
.the Peruvian bark, both by the mouth and in the form of vaginal in-
jections; that not succeeding with these, he had had recourse, in suc-
cession, to an immense number of stimulating and astringent articles;
that wearied, at length, at the continual changes of nauseous drugs,
^one of which had produced the desired effect, she had dismissed him,
and had consented to apply to me. I further learned, that the patient
discharged a very large quantity of matter from the vagina; that she
experienced much heat and some pain in the part, and that these
symptoms were much aggravated during, and for some time after
coition; that during her menses, which, in general continued to appear
in a pretty regular manner, the vaginal discharge evidently lessened
in quantity; and that the patient had lost a good deal of flesh. Her
skin was pale, and of an earthy colour, and generally became rather
warmer than natural towards night; her appetite was tolerably good,
but the digestive process was slow, and attended with sensations
of fulness and uneasiness in the stomach and bowels; she was gene-
rally thirsty, and finally, her bowels were very constipated.
From this enumeration of symptoms, I was led to the conclusion
that the disease, for which advice was demanded, depended on a
high grade of secretory irritation of the vaginal mucous membrane;
that this irritation extended probably as high as the neck or mouth
of the uterus, and that the internal lining of the digestive tube and
^he biliary organs were affected in a secondary ipanner. For th©
40 La Roche on Copaiba in Catarrh of the Bladder, ^"C,
purpose of removing this morbid state, bleeding from the arm or by
leeches appeared to be called for, and were ordered; but owing to
the fears and prejudices of the patient it was found impossible to
draw blood in any way. It became necessary, in consequence, to have
recourse to more slow and less efficient means, such as a low vegetable
diet, acidulated and emollient drinks, saline purgatives, rest in a
horizontal position, emollient vaginal injections, and tepid baths.
At the expiration of ten days I was informed that the leucorrhoeal
irritation, as well as the gastric derangement, had in some measure
diminished, but that the discharge continued as before. The balsam
of copaiba was now prescribed in moderate doses, and after a little
persuasion Mrs. B. consented to take it in cold chamomile tea. By
this means the quantity of matter discharged decreased somewhat in
less than a week; but as the copaiba occasioned considerable distress
in the stomach, pain in the bowels, and thirst, it was laid aside for
two or three days. It may be proper to remark that during the con-
tinuance of the gastro-intestinal irritation produced by the copaiba,
Mrs. B. became affected with a depression of spirits, amounting
almost to melancholy, and alternating with agitation and hysterical
symptoms. At the end of the above-mentioned period, I was
informed that the whole of these symptoms had subsided; but
that the leucorrhoeal discharge was again on the increase. The
patient was, in consequence, once more placed under the use
of the copaiba; but after a few days, owing to a recurrence of the
same symptoms, it was again discontinued. It was easy to find,
from what was stated by Mrs. B. and her attendants, that although she
could not continue the use of the copaiba more than four or five days
in succession, and it required two or three days more before the ir-
ritation occasioned by it had completely subsided, we were gaining
ground on the disease. The plan was on this account persevered in
during a few weeks; the vaginal irritation gradually decreased;
slightly astringent and tonic injections per vaginam were had re-
course to; a more substantial and nourishing diet was allowed, and
at the period of my departure for Europe, a few weeks after, Mrs. B.
was so greatly restored as to entertain the prospect of a speedy and
complete relief from the distressing disease under which she had so
long laboured, and for the cure of which a great variety of anti-leu-
corrhoeal remedies had been tried in vain.
There can be no doubt, that in this case, the copaiba, although
causing so much irritation of the gastric organs, as to force me
to several times suspend it during a few days, evinced considerable
power over the leucorrhoeal discharge. This we may infer from the
Harrises Cases of Epidemic Yellow Fever, 41
fact) that by its means a disease of already long standing, and which
had baffled the efforts of art, and it may be added of empiricism, was,
if not completely removed, at least greatly relieved. The patient
herself was fully aware of its utility; and nothing, probably, could
have induced her to resume so often the use of a remedy of a highly
nauseous taste, and producing the unpleasant effects stated, except
the conviction that it was producing the desired effects. As re-
gards myself, I frankly admit, that it was only the courage and the
wishes of Mrs. B. which induced me to persevere with the copaiba;
and that on two or three occasions I suggested the propriety of sub-
stituting some other remedy of a less irritating nature.
The second case of leucorrhcea described above, presents an in-
stance of gastric irritation brought on by mental depression. In the
third we have an example of the reverse — a state of mental depres-
sion, as well as hysterical derangement, produced by a gastric affec-
tion arising evidently from the action of a stimulating remedy on
a preternaturally irritable mucous tissue.
In the next number of this Journal I hope to be able to offer
some observations on the effects of the balsam of copaiba in diseases
of the. alimentary canal.
Art. II. Cases of the Epidemic Yellow Fever prevalent at New Or-
leans in the Summer and Fall of 1833. By E. B. Harris, M. D,
[Communicated to Dr. Samuel Jackson, of Philadelphia.]
1 HE following is the history of twenty cases of the late epidemic
fever prevailing at New Orleans. The number Dr. Harris writes
could have been increased to eighty, with an additional mortality of
two deaths.
The treatment pursued in these cases was based on physiological
medicine. They furnish an evidence of its applicability to the dis-
eases of the southern regions of our country: of this fact no rational
doubt could be entertained, but many who do not understand its
principles, and do not wish to recommence and continuously prose-
cute their medical studies, have made this assertion. It may be sus-
pected, this is often done as an apology for indolence, and a justifica-
tion of an adherence to established routine, rather than from convic-
tion, the result of deliberate examination.
It may be well to say a word in explanation of what is intended
4*
42 Harris's Cases of Epidemic Yellow Fever,
by physiological medicine, as it is grossly misunderstood, or quite
as badly misrepresented, by individuals whose position should
be a guarantee against either error.
In physiological medicine the pathology of disease is established
on the structure of the organs, their vital actions and functions.
Disease is a modification in the normal vital condition of structure,
(which includes both the solid and fluid elements,) whence proceed
change or disorder and disturbance of function and structure as ef-
fects. Therapeutics is the appreciation of the modifications caused
by medicinal agents in the vital condition of structure; and treatment
or practice consists in the adaptation of the therapeutic modification,
or vital reaction caused by remedial agents, to the pathological modi-
fication or vital reaction of the organs proceeding from morbific
causes.
Such are the fundamental principles of physiological medicine. It
is rational as opposed to routine medicine. It is opposed to and ad-
mits of no quackery, as it requires a profound knowledge of the ani-
mal organism, of vital phenomena, and the positive actions of reme-
dial means. This knowledge too is to be governed by the processes
of reasoning as applied to each particular case.
Physiological medicine, either designedly or ignorantly, is con-
founded with i\\Q physiological doctrine of Broussais. The medical
doctrine of this distinguished physician, which is the physiology of
irritation, is eminently physiological. It is the only general system
of medicine promulgated in France which took physiology for its
groundwork. It was, therefore, no presumption in Broussais to name
it as he did — the physiological doctrine. The term would have been
less applicable in Britain and this country, than in France. Brown,
Darwin and Rush, had promulgated doctrines founded exclusively
on physiology. The failures of these truly eminent medical philoso-
phers, are to be ascribed solely to the defective state of the physiology
of their time. With the paucity of their materials, and the imperfect-
ness of the science, it was not possible for them to erect a durable
fabric. The principles of Miller and of Rush, adapted to the phy-
siology of the present time, would approach very nearly the doctrine
of Broussais.
The doctrine of Broussais is an advance in the theory of medicine.
It has fixed more entirely the ideas of irritation, before exceedingly
loose, and given a clearer exposition of the numerous phenomena de-
pending on that vital condition, than any other that had preceded it.
It is to Broussais we are indebted for a more perfect knowledge of
the chronic irritative and inflammatory diseases, which had been by
Harris's Cases of Epidemic Yellow Fever. 43
the great mass of practitioners wholly misunderstood; and to this
knowledge is to be ascribed the present more successful methods of
treatment adopted in those affections. The improvements of Brous-
sais in these respects are incorporated in the body of the science, and
it is almost forgotten whence they proceeded. In the reaction also,
induced by the arrogancy, dictatorial spirit, and oftensive manners of
the man, are overlooked, in a great measure at the present period, the
services rendered by the philosopher and physician. Time, the vic-
tor of prejudices, and the calmer of passions, will do justice in this
respect.
The doctrine of Broussais will not be more permanent than its an-
tecedents. Its base is too narrow. It is but a stepping-stone in the pro-
gress of theory. No general theory of medicine, for a long period to
come, can be perfect or lasting. The facts of vitality and organization
are too little developed, and too little understood, to admit of an
entire theory that will be found unexceptionable. The most that can
be done, or that can be expected, is the temporary generalization of
the facts as they are now understood to render their application to
practical purposes more prompt and systematic.
Physiological medicine, or the arrangement and application to
practice of the physiological and structural organic phenomena, as
they become verified, has this advantage over a mere doctrine. It is
not tied down to a fixed set of what are considered positive facts, but
which are likely to be disproved as such in the rapid advance of
our positive knowledge. Its character is expansive and adapting, re-
pelling nothing that bears the impress of demonstration, and retaining
nothing proved to be untrue. As it is the philosophy of organic phe-
nomena applied to the purposes of medical science, every verified
fact that comes within its scope, or bears upon its principles, must
find its appropriate position and its useful application.
The strict pathology of yellow fever cannot be considered as posi-
tively settled. Some of its important facts are determined — others
remain obscure. That an intense gastro-duodenitis is its most promi-
nent character — that the primitive symptoms proceed from this
source, may be regarded as nearly unquestioned. The dissections of
Dr. Physick in this city first attracted attention to this fact, which
has since been confirmed by repeated observations. Dr. Rush made
the stomach " the seat and throne of the disease." Edward Miller
of New York, one of the ablest and most philosophical medical prac-
titioners of this country, assigned the stomach as the source— /ons et
origo — not only of yellow fever, but of all fevers of malignant cha-
racter.
44 Harrises Cases of Epidemic Tetlow 'Fevef.
While this general fact is indisputable, and the leading features 6f
the disease announce in unequivocal language the existence of an in-
tense gastro-intestinal inflammation, there prevails, however, a con-
stant disposition to heemorrhage, or at least to the escape of the colour-
ing matter of the blood from the inflamed gastro-intestinal mucous mem-
brane. This may be regarded as the specific character of the disease.
•1 have never witnessed a fatal case of yellow fever in which this was
• absent. Even when no black vomit is ejected during life, it is always
found in the stomach on dissection. From the number of autopsies I
have assisted at or performed in this disease, I regard this as one of
the most positive facts of the disease. In very violent cases the same
bsemorrhagic disposition is manifested in other points, as the mouth,
the ears, the carunculse, the bladder.
This symptom is present only in the fatal cases — at least I have
never known a recovery when it has existed. There are traditions of
some few cases in the epidemics anterior to my personal observations,
which commenced in 1805, in which recovery had taken place after
black vomit and bloody discharges. They are exceedingly rare.
What is the immediate cause of this haemorrhagic disposition is un-
known. It may reside in the blood itself. But it appears to be regu-
lated by the intensity of the local inflammations. The treatment of
the disease should then be directed entirely to the restraining of this
last condition. If that be confined below a certain grade, the fatal
complication is prevented. The recuperative powers of the organism
are preserved, and will prove adequate to the safety of the patient-
The physician can accomplish, and should attempt no more. The
x:ase is precisely analogous to that of the exantheraatous fevers derived
from specific contagions, and possessing a specific character. No one
attempts to cure the disease. Their danger arises from the intensity
of the local infiammations that invariably attend them, disturbing the
functions of important organs, and disordering the whole constitution
of the individual. The protection afforded against these inflamma-
tions by a treatment that limits their too great activity, is the extent
of our remedial proceedings. No remedies are possessed of specific
powers adapted to the specific character of the disease capable of ar-
resting its progress. By mitigating the intensity of local inflamma-
tions, fatal complications are prevente<l, and then the patient reco-
vers. When the too great virulence of the contagious poison or the
state of the constitution, or organs of the patient, is such as to occa-
sion inflammations of an activity beyond t!ie reach of &ur curative
operations, disorganization and the destruction of fun<;tions essential
to vital activity then ensue, and the patient perishes.
Harris's Cases of Epidemic Yellow Fever, 45
In the following cases, reported by Dr. Harris, this course was fol-
lowed. Neglecting the specific character of the disease, of which we
have no positive information, and for which still less do we possess
any positive remedy, the whole treatment consisted in the employ-
ment of means the most directly calculated to diminish the local in-
flammation in the organs where they are the most actively developed.
The plan is rational, and the success was gratifying. By keeping
down the too great intensity of the gastro-intestinal inflammation, the
secondary symptoms and the hsemorrhagic disposition were con-
trolled, and the cases remained within the ordinary curative powers
of the economy.
Dr. Harris was a resident physician of the Alms-house Infirmary
of this city, and he there witnessed the application of the method he
has pursued in the treatment of fever. This method is simple. It
consists in combating in its acute state, the gastro-intestinal inflam-
mation, and the secondary train of symptoms it excites in the ner-
vous organs, by the most powerful, yet simple and direct of the se-
dative and antiphlogistic means we possess. These are general bleed-
ing, to limit the two great activity of the general circulation. Capil-
lary depletion to attack immediately the local or capillary affection.
Cold, the only true sedative and positive febrifuge, to concur in the
same object, and to allay the excitement of fever. Revulsion, accom-
plished by warmth to the extremities and cold to the head, equa-
lizing the excitement, and preventing cerebral congestions, and epis-
pastics or sinapisms, when the violence of reaction has been subdued.
Finally, the employment of the milder purgatives calculated to call
forth the intestinal secretions, when the inflammatory condition has
been properly combated, terminating its last remains, or carrying oiF
a congestion that may have been formed. Mercurials administered
at this period, and in some cases carried to the point of light ptyalisra,
often are the most effectual for this last object.
The most important of these remedies in the commencing stages,
the most efficient of all remedies in the acuity of fevers, (to employ
an old phrase,) are local depletion and cold. This last is to be em-
ployed in ablutions, or persistently to the head and to the abdomen when
their temperature is elevated; cold affusions to the head, and injections
into the bowels. I know of no remedy that so truly merits the ap-
pellation of febrifuge as this last. Its effects in controlling, subduing,
and calming a febrile paroxysm are often wonderful. When the tem-
perature is sufficiently low, which must be regulated by the intensity
of the febrile heat, it is more prompt and powerful than the most
copious blood-letting, while no danger is incurred of producing ex-
46 Harris's Cases of Epidemic Yellow Fever^
Imustion should the disease progress, often fatal when too copious
evacuations have been practised.
The experience of Dr. Harris of this method of treatment, in the
fevers of the southern states, has been sustained by that of EVr. Ed\vari>
Barton, formerlj'" of Louisiana, but at present of New Orleans. Dr-
Earton has published the result of his observations in this Journal,
¥oL XI, p, 43, €t seqo ■ S. J.]
€ase L — 'Mr. M*C. aet. 28, sanguine-ljrnphatic temperament, first
summer in New Orleans, was seized, August 20th, 1833, about 6 P.
M. with chill, pain in stomach and head and lower part of spine, ge-
neral uneasiness in his bones. I was called at 7 P. M. and found
|3ulse 140 atid full, skin hot, pain in epigastrium, vomits mucus mixed
with gruraous blood, great stupor, bowels constipated, tongue be-
ginning to ^e furred and red at edges. 01. ricin. 5iss. ; injection
of ol. ricin. 5ij., molasses, 5ss., and mucilage, §viij. mixed well.
The injection to be repeated every hour until the intestines are fully
evacuated. Fifty leeches to epigafctrium: cold aflfusion to head; iced
barley water for drink, and diet. 10 P. M. The leeches have drawn
well; sickness of stomach calmed; head-ache diminished; pulse re-
duced to 120, and not so full; skin slightly disposed to moisture;
bowels freely acted on. Ordered a warm bath, with cold aifusion to
•head while in bathing tub.
21s^, 6 A. M. Still complains of his head; stomach tranquil; tongue
furred in middle and red at centre; pulse 110; bowels freely acted
on during the night; desire for his iced drinks, as cold water and
barley water, which were given often, but in small quantity at a
time. Ordered eight leeches behind each ear, warm bath with cold
aftusion repeated, and injection as before. 12 M, Head felt much
relieved after the leeches were applied; urinates freely, deep red;
pulse 100; skin perspirable; tongue in same condition; head feels but
slightly heavy. Continue treatment. 8 P. M. Head still feels
heavy; bowels have been opened several times in the day; condition
otherwise unchanged. Ordered eight leeches to inside of thighs;
cold mucilage injection; at 10 P. M. the bath, and affusion to head.
22(i, 6 ^. M. Slept several hours last night; feels no pain or un-
easiness; redness of tongue at edges much lessened; desire for cold
drinks decreased; pulse 90; skin perspirable; a little nausea; urine
becoming almost natural. Soda pulv. with tart, acid in effer-
vescence occasionally. 8 P. M. Saw him several times during the
day; the soda powders relieved the nausea of which he complained;
pulse 85, and good; tongue improved in appearance. Ma«8. ex
Harris's Cases of Epidemic Yellow Fever. 47
liydrarg. grs. v. ; arrow root in addition to his barley watery injection
of mucilage.
23 J, 6 A. M. Slept wellj bowels freej convalescing; pulse 89,
Continue regime.
24M, 6 A. M. Continues to improvei stools present a dark aspect.
Continue arrow root and barley water.
^5th. Condition unchanged; allowed chicken water.
26//i. Doing well. Allowed chicken soup.
27//i. Discharged, with restrictions as to his diet. On 28th he is
up in his room.
Case II. — Mr. Wells, set. 30, sanguine-lymphatic temperament,
first summer in the city, was taken at 8 A. M. August 22d, 1833,
M'ith chill, pain in lower part of back and bones. At 10 A. M. I
'was called, and found him in the following condition: — Greatly
frightened, and crying; pulse 130, and full; bowels constipated; heat,
and soreness of epigastrium on pressure; skin of abdomen hot; head-
ache. 01. ricin. §iss.; fifty leeches to epigastrium; injection of
ol. ricin. 5ij.; molasses, 5ss. ; mucilage, 5viij. mixed together; the
injection to be repeated every two hours, until there are free evacua-
tions. Cold barley water for diet and drink; cold affusion to head.
S P. M. Pulse reduced to 110; leeches drew well; pain in sto-
mach but slight; head-ache diminished; skin hot; tongue becoming
furred and red; urine of a deep red, and depositing a lateritious sedi-
ment; bowels freel}^ opened. Ordered eight leeches behind each ear;
repeat injection; tepid bath, with cold affusion to head; iced barley
water. 8 P. M. Head-ache lessened after the application of the
leeches; bowels freely evacuated; abdomen much diminished; mind
less agitated; condition otherwise unchanged. Ordered cold muci-
lage injection; bath, with cold affusion to head at 10 P. M. ; continue
cold drinks.
23J, 65 Jl, M. Slept two or three hours last night; mind much re-
lieved; tongue furred and red at edges; pulse 95; dullness of head
but slight; forehead a little disposed to moisture; slight nausea;
bowels open. Ordered a warm pediluvium, and pulv. sod, and tart.
acid in etfervescence. 8 P. M. Has passed a tolerable comfortable
day; several evacuations from intestines; no uneasiness in head:
tongue not so red at edges; pulse 85; urine high-coloured, (red;)
nausea relieved; thirst not very urgent. Cool flaxseed injection;
continue drinks.
24//i, 62- A. M, Rested well last night; pulse 75; bowels open;
larine less deep in colour, and sediment not so abundant; tongue not
so red at edges, but furred, of a blackish colour in the middle; does
48 Harris's Cases of Epidemic Yellow Fever,
not complain. Thin arrow root by sips every hour or two, in addi-
tion to barley water. 8 P. M. Saw him during the dayj no change.
A warm pediluvium; mass. hydr. grs. v. at 10 o'clock.
25//i, 6i, A, M. Has slept several hours during the night, but as
he has charge of an extensive concern, and all absent but himself,
his mind is either much affected thereby, or by some other cause; he
is now shedding tears; otherwise condition unchanged; tongue clean-
ing off. Mucilage injection. Continue treatment. S P. M, I find
now his condition much changed, and on inquiry ascertain that his
friends have been continually coming in and talking to him during
the day. His tongue is red and fiery; pulse 110, quick and weak;
skin hot; partial insensibility. Tepid bath; continue barley water.
£6//i. Condition aggravated; prostrated; tongue red and chipped;
mind so much disturbed as to be delirious; partial insensibility.
Arrow root, (thin,) and barley water, with a continuance of in-
jections of mucilage.
In the above condition, but more prostrate, he remained until the
29th, when his pulse became a thread, and I ventured, in opposition
to my judgment, and a fear that he would sink during the night, an
injection of carb. ammon. in mucilage, every three or four hours.
They v/ere continued until next evening, when, no change for the bet-
ter being perceived, they were discontinued. He was now put in a
tepid bath, and confined to arrow root, barley and iced water. About
the 5th of September his dryness of tongue and body began to disap-
pear, and on the 7th all diseased appearances were absent. He was
now almost a perfect skeleton. Allowed chicken soup. On the 12th
he is enabled to walk with assistance. Discharged, with cautions as
to regimen.
Case III.-— Mr. S. W. set. 20, sanguine temperament, has been in
New Orleans several winters, but went north every summer; a native
of Philadelphia; was seized on Monday afternoon, August 26th, 1833,
with a slight chill and pain in the head and lower part of the back,
succeeded by slight fever. I saw him about/ P. M. three hours after
attack. His pulse was 110, and he complained as above but slightly;
his bowels were constipated; slight sickness of stomach. 01. ricini,
^j. to be succeeded by injections of ol. ricini, ^ij. with molasses,
5ss. and flaxseed mucilage, §viij. The injection to be repeated
every two hours until the bowels are fully acted on. Twenty leeches
to epigastrium; cold affusion to head; cold barley water for diet and
drink.
27//i 7, j3. M. Head -ache and nausea much relieved; pulse 100;
skin but little excited; bowels freely evacuated; tongue slightly
Harris's Cases of Epidemic Yellow Fever. 49
furred and red at edgesj urine of a deeper red than natural; press-
ing on stomach does increase its uneasiness; has an anxiety and dul-
ness of expression I do not like, and is drowsy, although he slept
much last night. Ordered injection repeated; tepid bath, with
cold affusion to head; continue barley water. 8 P. M. Saw
him several times in the day, but without any alteration in ob-
servation or directions. Bowels freely opened; does not com-
plain of any pain, except uneasiness in the head. There is, not-
withstanding, an unnatural fulness of the abdomen for one who has
been so copiously evacuated; tongue but little furred or red at edges;
pulse 90. Repeat injection; tepid bath, with cold affusion; eight
leeches to epigastrium.
QSth, 7 A. M, Still continues to be much disposed to sleep; pulse
85; urine now red, and depositing a lateritious sediment; does not com-
plain of pressure made on epigastrium; bowels several times opened in
the night, by the injection; skin cool and pleasant; appearance of ful-
ness in the bowels still continues; tongue cleaning. Injection of
.cool flaxseed mucilage, to be repeated at 12 M.; mass, ex hydrarg.
grs. v. mane et midi. 8 P. M. Saw him several times in the day;
does not complain; no difference in observation from last notice, ex-
cept an increase in thirst. Tepid bath; repeat injection; ice to be
allowed to dissolve in the mouth; continue barley water.
29^/«, 7 .^. M, Every organ except the brain seems now to be unem-
barrassed and performing well its duty; there is continuance of a dis-
position to drowsiness and listlessness; bowels open, and discharges
yellowish; urine approaching to natural; tongue but little furred, and
no redness at edges; very slight nausea; pulse 80. Sodoe carb. with
tart, acid, in effervescence, to be repeated occasionally if nausea con-
tinues; repeat injection of flaxseed mucilage; warm bath, with cold
aftusion to head. 8 P. M. Does not complain; drowsiness much
diminished; is tranquil; pulse 80, and good; skin on forehead moist;
bowels open and yellow. Thin arrow root, by tea-spoonful at a
time, every hour or two; sponge body, when not moist, with whiskey
in the night; a warm pediluvium, with mustard.
SO^A, 7 A. M. A little restless in the night; all appearances good,
except a fulness of abdomen to the touch; desires to eat. Con-
tinue treatment.
31s/, 62 Ji, M. Saw him several times yesterday, but without any
change from last observation; still desires to eat. Allowed weak black
tea; continue arrowroot. 10./?. M, While passing, called in by accident
to see him, and, to my surprise, found a change in his visage; lips slightly
purpled; listlessness. Inquired, and ascertained that he had heard of
No, XXVII.— May, 1834. 5
50 Harris's Cases of Epidemic Yellow Fever.
the death of an intimate friend in the house, who died that morning,
in the next room to him. Has not urinated since morning, Epispas.
to epigastrium; flaxseed mucilage and spts. nitri. dulc. for an injec-
tion; continue barley water. At 12 M. he sent to me, and stated
he had hiccups, and wanted to know what would relieve him, as
they were, to use his own words, "troublesome." I repaired to him
immediately, and found his lips and visage still more changed to pur-
ple; hiccoughs, which are convulsing. I stated his situation to his
brother, who was unaware of the change. Dr. T. Hunt saw him
with me at 3 P. M. Passes no urine yet; no delirium, but entire
listnessness. Injection of mucilage and spts. nit. repeated; pe-
diluvium with nitro-muriatic acid, ^j.; epispastics to ankles. At 8
P. M. we saw him again; his condition was unchanged. I was now
sent for twenty miles below the city, to see my friend Dr. Rushton,
who, on a visit the evening before to a friend, was severely seized
himself. My friend Dr. Hunt had the kindness to attend my patients
in my absence, and from him I learned, that this patient continued
to grow worse, with complete relaxation of the sphincter ani, until
the next evening, when he expired. An epispastic was put on the
spine in addition to the above treatment. An opportunity for po&t
mortem examination was not offered.
Case IV. — Mr. L. C. set. 31, a merchant, (iirst summer residence
in the city, although he has resided here since 1829 during winter,
spring, and in summer until about 1st August,) sanguine temperament,
after a great deal of fatigue in sitting up with sick friends, was
affected, August 27th, with slight head-ache, and pain in lower
part of back, and uneasiness in bones. Saw him an hour after
attack, at 8 P. M. when he presented the following symptoms: —
Pulse 100; tongue, on projection, tremulous; uneasiness on pressing
epigastrium; skin of abdomen slightly hot; bowels constipated; a lit-
tle head-ache; pain in his lumbar region, and general uneasiness, as
stated; thirst. Fifteen leeches to epigastrium; ol. ricini, §iss. to
be followed in two hours by an injection of ol. ricini, molasses, and
flaxseed mucilage; the injection to be repeated every hour until the
bowels are freely evacuated. Cold barley water.
28fA, 6| *d. M. Leeches drew well; pulse 90; bowels freely acted
on; pain of epigastrium and back much relieved; tongue furred and
slightly red at edges; dull sensation in head; urine high-coloured,
and depositing a lateritious sediment; slept several hours last night;
temperature of skin decreased. Six leeches behind each ear; a warm
bath, with cold affusion to head; repeat injection; continue barley
water. 8 P. M, Saw him several times in the day. Doing well; pulse
Harris's Cases of Epidemic Yellow Fever. 51
now 85^ does not complain; had several stools; urine less high-colour-
ed; slight sickness of stomach. Pulv. bi-carb. sod. and tart, acid
in effervescence; warm pediluvium, with mustard; a cool mucilage
injection at 10 P. M. Mass. ex hydrarg. grs. v. to be repeated early
in the morning.
29/A, 6| Jl. M. Sickness of stomach relieved immediately after
the exhibition of the soda; pulse 80; tongue cleaning; urine becoming
natural; skin good; does not complain; desires food. Arrow root
in small quantity and often repeated; continue drinks.
30^A, 6| *^. M. Saw him several times yesterday; doing well; dis-
charges from bowels yellowish, tinged dark.
Slst. Convalescent; allowed chicken water; forbid to take exercise.
September Is?.— Discharged well, with restrictions as to regimen.
Case V. — W. F. set. 21, a clerk, sanguine-lymphatic tempera-
ment, (second summer in the city,) was attacked, September 8th,
1833, with chilliness, head-ache, pain in lower part of back, sickness
at stomach. Saw him a few hours after attack, when he presented the
following symptoms. Pulse 130, and full; tongue covered with a
white fur, and red at edges; pain on pressing epigastrium; skin
hot; head-ache; bowels constipated; pain in lumbar region; thirst.
Twelve cups to epigastrium and right and left hypochondrium, and
six to lumbar region; ol. ricini, ^iss., to be followed in three hours
by an injection of ol. ricini, ^ij., molasses, ^j., and mucilage of
flaxseed, §viij.; the injection to be repeated every two hours,
until the bowels are freely acted on; cold aftusion to head; cold bar-
ley water for diet and drink.
9^^, 65 A. M. Passed a restless night; pulse reduced to 100, and
not so full; head-ache much lessened; sickness of stomach relieved;
skin of forehead rather hot; bowels freely acted on; urine of a deep
red, and depositing a lateritious sediment; thirst not so great; pain
in lumbar region almost entirely abated. Eight leeches behind
each ear; repeat injection; ice in small pieces allowed to dissolve
slowly in the mouth, in addition to the barley water; tepid bath, with
cold affusion to head. 8 P. M. Has passed a more comfortable day.
Tongue covered with a white fur, but moist, and less red at edges;
pulse reduced to 90; head much relieved by the leeches and cold
affusion; bowels opened several times; thirst lessened. Injection of
cool flaxseed mucilage, and at 10 P. M. a warm bath and cold affu-
sion, as above.
10th, 65 A. M. Passed a tolerable night; slept several hours;
pulse 85; tongue less furred and red; does not complain; urine less
513 Harris's Cases of Epidemic Yellow Fever.
deep colour; bowels open. Arrow root in small portions and often
repeated; cool flaxseed mucilage injection repeated.
Wth, Continues much in same condition, except a desire for nour-
ishment different from his arrow root, which was not allowed; he is
much prostrated. Continue treatment.
\'2.th» Yesterday, after my mid-day visit, he attempted to sit up in
bed to stool, and swooned away, from which he, however, soon re-
covered. His tongue is cleaning, and his condition good. Con-
tinue treatment.
loth. Continues to improve; stools yellow. Continue treatment.
14M. Desires urgently to eat. Allowed chicken soup.
\5th. Convalescent.
\^th. Discharged well, with restrictions as to regimen.
Case VI. — Mr. M. set. 22, fully developed, sanguine temperament,
first summer in New Orleans, was attacked very severely, September
5th, 18SS, with chill, pain in head, back and bones, sick stomachs
I saw him an hour after he was taken, and the following symptoms
were observed. Pulse 140, and full; skin hot; abdomen hot, and
epigastrium painful, pain increased on pressure; bowels constipated;
ardent thirst. Twelve cups to epigastrium, right and left hypo-
chondrium, and six to lumbar region of spine; §iss. of ol. ricini, to
be succeeded by an injection of ol. ricini, molasses, and flaxseed mu-
cilage, every one and a half or two hours, until the bowels are freely
acted on; cold barley water for diet and drink. This was at 10 A. M.
9 P. M. Head-ache still continues, but much diminished in seve-
rity; tongue furred and red; skin hot; epigastrium painful on pres-
sure; pulse reduced to 120; cups drew well; urine of a deep red;
bowels freely opened; thirst continues. Injection repeated; tepid
bath with cold aifusion to the head; cold drink continued, with ice
allowed to dissolve in the mouth.
6/A, k to 7 *B. M. Passed a restless night, without sleep; bowels
several times opened; urine deposites a lateritious sediment; head-
ache and other symptoms, as above, unchanged. Five cups to
back of neck; injection of cold mucilage; warm bath at 10 A. M.
with cold affusion to head. 9 F. M. Saw him during the day; pulse
now reduced to 100, and much less full; only uneasiness in the head;
redness of edges of tongue not so deep; heat of skin greatly lessened;
bowels free; urine of a less deep red. Pediluvium; continue barley
water; cold to head.
7th, 7 ^. M. Passed again a restless night, (a symptom, as far
as my observation extends, in the commencement of yellow fever, of a
Harris's Cases of Epidemic Yellow Fever. 53
favourable character,) with only an hour or two of sleep; tongue coat-
ed with a grayish fur, inclining to brown; dullness yet in head; pulse
95, bowels free, and discharges slightly yellow. Five leeches be-
hind each ear; continue treatment. 9 P. M. Feels comfortable;
does not complain; pulse 90; tongue and other appearances but little
if any changed; slight moisture on forehead; bowels open. A pedi-
luvium with mustard; thin arrow root, by tea-spoonfuls, every hour
or two; a mucilage injection; barley water or orangeade, which latter
he calls for, (thirst much lessened.)
8th, 7 Ji. M. nested well; does not complain; much pros-
trated; pulse 85; tongue cleaning and less red at edges; stools yel-
low. Continue treatment.
9/A, 7 ^. M. Saw him several times yesterday; no change in ob-
servation, except that his eyes and body are becoming very yellow.
He continued without material change until the 12th, when he de-
sired chicken soup, and was discharged well on the 13th, though
perfectly yellow. This soon disappeared.
Case VH. — Mrs. C. set. 22, sanguine-lymphatic temperament, spent
the summer of 1831 in the city, has an infant about ten months old,
was seized, on September 7th, 1833, at 8 P. M. with pain in head,
lower part of back and stomach, preceded by a chill and uneasiness
of bones, and languor; bowels constipated. I was called at 9 P. M.
but owing to indisposition did not go, but prescribed the following:—
Thirty leeches to epigastrium; ol. ricini, §jss. to be succeeded
by injections of ol. ricini, molasses, and mucilage, in two hours; cold,
affusion to head; barley water for diet and drink.
Sth, 7 Ji. M. Passed a restless night; pain of head and stomach
not much lessened, as the leeches could not be procured, and a few
that were applied by the family drew but a small quantity of
blood; bowels have been freely evacuated for eight times; pulse 130,
and full; skin hot; pain of epigastrium increased on pressure; tongue
furred and red at edges; urine of a deep red. Forty leeches to
epigastrium; repeat injection; cold affusion to head; continue cold
barley water. Q P. M. Head-ache much lessened after the application
of the leeches, the bites of which were allowed to bleed; pulse re-
duced to 115, and less full; heat and pain of epigastrium much less;
slight sickness of stomach; urine and tongue as last noticed; bowels
open several times in the day. Bi-carb. sod. with tart, acid occasionally,
in effervescence; six leeches behind each ear; warm bath, with cold
affusion to head; an injection of cool flaxseed mucilage; as thirst is
urgent, ice is held in the mouth and allowed slowly to dissolve.
9/A, 7 <^.. M, Slept several hours last night j was much calmed hj
5*
54 Harris's Cases of Epidemic Yellow Fever.
the leeches, which drew well, and the cold aflfusion was most grateful
to herj sickness of stomach relieved^ tongue furred, white, but redness
at edges nearly gone; bowels open several times, but discharges mostly
mucus and water; pulse 95; still a slight pain in head; urine becoming
of a paler red; thirst not so urgent; skin still warm on abdomen
Mass. ex hydrarg. grs. v. to be repeated at 12 M.; warm pediluvium
cold cloths to head after cold affusion; cold flaxseed mucilage injec
tion; continue barley and iced water. 9 P.M. Head-ache but slight
pulse 85 to 88. Add mustard to warm pediluvium; repeat injection;
continue treatment.
11th, 7 *fi. M, Tongue much improved, and now but little furred;
stools darkish-brown; complains but of slight dulness of head; urine
nearly natural; pulse 80; skin slightly disposed to moisture, and
pleasantly cool. Repeat mustard pediluvium and mucilage injec-
tion; thin arrow root in addition to her barley water, (her thirst has
been gradually declining.) 9 P. M. Condition good; continue treat-
ment.
12/A, 7 A. M, Slept well; desires to eat. Continue treatment.
l%ih. Condition improving; all organs doing their duty. Pa-
nada in addition to her other nourishment.
l\th. Desires imploringly to be permitted to eat more; allowed
chicken soup.
15/^ and 16th. Discharged well, with restrictions as to regimen.
Case VIII. — D. F. from New York, a youth of sixteen, was
here last summer, sanguine-nervous temperament very highly de-
veloped, was affected on the 11th of September, 1833, about 11 A. M.
with chilliness, pain in bones after exposure on the day before
to the direct rays of the sun on the levee, attending to the re-
ception of goods. I saw him about 1 P. M. when he had severe pain
in head and lower part of back; pulse 140, and full; skin very hoU
particularly over epigastrium and abdomen; pain in epigastrium much
augmented by pressure; tongue red and tremulous on projection;
bowels constipated; thirst. Ten cups to epigastrium, right and
lefthypochondrium, five to lower part of back; ol. ricin. ^j. to be fol-
lowed in two hours by an injection of oil, molasses, and flaxseed
mucilage every two hours until bowels are freely acted on; cold
affusion to head; cold acidulated barley water for diet and drink.
85 P. M. Feels a little relieved by what has been done; the cups
drew well; pulse 130; pain in head still intense; bowels freely acted
on; skin hot; strong desire for cold drinks; tongue becoming much
furred and red at edges; stomach not so painful on pressure; urine of
a deep red, and depositing a lateritious sediment Four cups to
Harris's Cases of Epidemic Yellow Fever. 55
nape of neckj repeat injection; at 10 P. M. a tepid bath, with cold
affusion to head; ice in gauze allowed to dissolve in the mouth; occa-
sional sponging the body during night with whiskey, and cold to
head.
12^^, 6? Jl. M. Passed a restless night; pulse 120; tongue greatly
furred, white and red at edges; bowels open several times last night;
head-ache continues, but diminished in violence; slept none; urine and
other symptoms as noticed, except a slight pain in stomach, with
nausea. Cold flaxseed mucilage for injection; two cups to epi-
gastrium, which he strongly protests against; tepid bath, with cold
affusion to head; carb. sod. and tart, acid occasionally in effervescence.
85 P' M, Saw him during the day, and directed repetition of cold
injection; pulse 115; head still painful, yet slight sickness of stomach;
condition otherwise unchanged. Repeat injection; tepid bath, with
cold affusion, to remain in the bath for twelve or fifteen minutes;
sponge body every hour or two through the night with whiskey; con-
tinue drinks.
13//i, 65 A. M. Passed another restless night; pulse 105, and less
full; head-ache much lessened; not so furred a tongue, nor redness of
edges; urine less deep in colour; skin too warm, and not perspirable;
bowels open in the night; thirst continues; sickness of stomach re-
lieved. Repeat injection; tepid bath, with cold affusion to head,
and cloths wrung out of iced water constantly to head after the affu-
sion; mass, ex hydr. grs. iv. to be repeated at 12 M. ; continue
drink; orangade as he desires it. 85 P. M. Saw him during the
day; pulse 95; head still aches; condition unchanged; the family
became alarmed, and Dr. Hunt saw him with me. Eight leeches be-
hind each ear; repeat bath, with cold affusion to head; repeat injec-
tion; continue sponging body with whiskey; drinks continued.
14?/i, 6| d. M. Was much relieved by the leeches; bowels open;
head aches but slightly; complains of a little pain when pressure is
made at region of scrobic. cord.; pulse reduced to 85; skin disposed
to moisture, and greatly reduced in temperature; tongue less furred,
and redness of edges almost absent; slept several hours in the night;
is extremely sensitive, and fears the application of a cup to seat of
pain in epigastrium. One cup to scrobic. cord. ; repeat injection,
and bath with cold affusion; a little thin arrow root in addition to his
other drink. 8 P, M. Saw him in the day, and directed repetition
of injection; pulse now 80; urine assuming a natural appearance;
tongue cleaning; skin moist; slight nausea. A warm pediluvium,
with addition of mustard; repeat injection; a small epispastic to epi-
gastrium, to remain on for three or four hoursf continue sponging
56 Harris's Cases of Epidemic Yellow Fever.
abdomen with whiskey every two or three hours; otherwise continue
treatment.
15th, 6i J3. M. Passed a comfortable night; rested well; discharge
from bowels assuming a dark colour, and of some consistence, and
does not complain since the removal of the epispastic, which entirely
relieved sickness of stomach; tongue nearly natural; pulse 80. Con-
tinue treatment.
16th, 7 A. M. All organs in a good condition; desires to eat; al-
lowed a small piece of toast, and weak black tea.
17th and ISth. Allowed chicken soup, and discharged well on 19th,
with restrictions as to regimen; he is much reduced.
Case IX. — Mr. A. B. H. a merchant, has been in New Orleans
several years, but absent for the last two or three summers, most of
the time to Omoa, Tuxillo, &c. ; he is of a sanguine temperament,
and arrived within a week from Omoa; set. 32. He was taken with
a chill and pain in his bones, and sick stomach, September 13th,
about 12 M. I was sent for, but did not see him until 2 P. M. when
he presented the following symptoms: — Pulse 135; bowels consti-
pated; tongue red and tremulous on projection; severe pain in head
and lower part of back; thirst great; skin hot. Twelve cups to
epigastrium, right and left hypochondrium, six to lower part of back;
ol. ricin. ^iss., to be followed every two hours by oil, molasses, and
mucilage, as an injection, until bowels are freely acted on; cold
barley water for diet and drink. 7 P. M. Pulse reduced to 115,
and less full; tongue furred and red at edges; bowels acted on seve-
ral times; urine of a deep reddish colour; pain in head, back, and
stomach much lessened after the application of the cups, which drew
well; abdomen hot; thirst continues. Repeat injection; and at 9
P. M. a tepid bath, with cold affusion to head; continue barley water
iced.
lAth, 7k «^' M, Passed a restless night; bowels opened four or
five times during the night; pain in head, particularly across the
eyebrows; urine deep as last noticed, and depositing a lateritious se-
diment; no pain or sickness of stomach; pulse 110; skin reduced
slightly in temperature; thirst not so intense. Warm bath with
cold allusion to head; an injection of cold mucilage; continue iced
barley water; four cups to nape of neck. 9 P. M, Visited him
during the day; head much relieved after cupping; tongue furred,
as last noticed, but redness of edges decreased;^ pulse 100; bowels
open; urine not so high coloured; temperature of skin becomings
more natural; does not complain. R. Mass. ex hydrarg. g;rs. v»
nocte et mane.
Harris's Cases of Epidemic Yellow Fever, 57
15th, 6| A. M. Passed a tolerable comfortable night, having slept
several hours; pulse 90; bowels open; skin disposed to moisture;
tongue beginning to clean; not much thirst. A warm pediluvium;
thin arrow root by tea-spoonfuls at a time every half hour or hour;
cool mucilage injection; continue barley water. 9 P. M. Pulse 85;
complains of slight uneasiness of head; urine nearly natural. A warm
pediluvium, with the addition of mustard; cool mucilage injection
repeated; continue barley water and arrow root.
l6;/i, 7 S., M, Bowels assuming a dark colour, and of some con-
sistency; no uneasiness in head; tongue yet furred in middle, but no
redness of edges; skin and pulse good. Continue treatment,
with the addition of the juice of an orange, which he desires.
17//i, 7 Ji. M, Saw him last evening, but without observation; he
slept well; desires food, which was refused; continue treatment.
18//«. All disease gone; stools yellow; desires to eat. Allowed
weak black tea and toast, and chicken water during the day.
20^/j. Discharged well, with restrictions as to regimen.
Case X. — Mr. H. a bookseller, set. about 35, has been in the city
for twelve or fourteen years, temperament sanguine-lymphatic, the
latter most strongly developed, tall stature, has his family across the
lake, was seized September 13th, 1833, about 1 P. M. with chilliness;
pain in bones; languor, succeeded by fever; severe pain in head,
lower part of back, and stomach; (he had been in the habit for some
time of taking a small quantity of brandy and water once or twice
daily. ) I was sent for, and saw him at 3 P. M. when the following
observations were made: — Pulse 125; skin hot; pain in head, lower
part of back and epigastrium, the latter increased on pressure; tongue
red and tremulous on projection; bowels constipated; uneasiness of
mind; thirst great for cold drinks. 01. ricin. ^iss. to be suc-
ceeded by an injection of oil, molasses, and flaxseed mucilage in two
hours, to be repeated until bowels are freely acted on; ten cups to
epigastrium, right and left hypochondrium, six to lower part of spine;
cold barley water for diet and drink. 9 P. M Pulse reduced to
110, and less full; temperature of skin diminished; tongue beginning
to be furred and red at edges; sensibility of epigastrium and pain in
head lessened; urine of a deep red colour; bowels have been acted on
several times; the cups drew well; thirst continues. Repeat injec-
tion; tepid bath, with cold affusion to head, if head-ache then not re-
lieved, eight leeches behind each ear; continue drink.
14//i, 6 A, M. Passed a restless night; the leeches were not ap-
plied, as the pain in head diminished; urine depositing a lateritious
sediment; tongue furred deeply, and red at edges; pulse 105; skin of
58 Harris's Cases of Epidemic Yellow Fever.
abdomen hot; bowels open duringthe night; a little sickness of stomach.
Apply the leeches as directed last night; warm bath, with cold affusion
to head; cold mucilage injection; carb. sod. and tart, acid occasionally
in effervescence; continue barley water and ice water in small quantity.
9 P. M. Head much relieved; tongue not so furred and red; bowels
open several times during the day; pulse 95; urine as noticed; sick-
ness of stomach relieved; skin of forehead a little disposed to mois-
ture. Mass. ex Hydrarg. grs. v.; a warm pediluvium; continue
treatment.
15/A, 6 Jl, M, Got into a slight perspiration after the pediluvium;
slept several hours in the night; complains only of a slight ful-
ness in the head; pulse 90; tongue improved; urine less deep in co-
lour. A warm bath, with moderate cold affusion to head; injec-
tion of cool flaxseed mucilage; thin arrow root, in addition to other
drinks. 9 P. M. Visited him during the day; feels much relieved;
abdomen reduced very greatly in size; bowels open. Continue treat-
ment.
16M, 6 A. M, Stools now present a dark colour, and more con-
sistence; does not complain; tongue improving. A warm pedilu-
vium with mustard added; continue treatment.
17 th and IStk. Continues to do well.
19/^. Desires porteree — allowed a small portion at a time, also
chicken soup.
20th, Discharged well: and on 23d, was enabled to go across the
lake.
Case XL — Mr. A. M. a merchant, set. 25, sanguine-lymphatic tem-
perament; the latter most strongly developed; of a very tall stature;
has been in New Orleans for three summers; had intermittent fever
last spring, and is subject for some time during every change of wea-
ther, when it becomes damp and cool, to attacks of St. Anthony's
fire, in many of which I have attended him; had a severe attack not
more than ten days ago.
He was seized about 11 A. M. with chilliness, pain in head, back,
and stomach, succeeded by high fever. I was called, but being ab-
sent did not see him until 4 P. M. when the following symptoms
were observed: — Intense pain in head, stomach, and lower part of
back; pulse 140 and full; bowels constipated; skin hot; pain of epi-
gastrium increased on pressure; tongue red and tremulous; very much
alarmed. Twelve cups to epigastrium and right and left hypo-
chondrium; eight to lower part of back; ol. ricini, ^iss., to be fol-
lowed by injections in two hours of oil, molasses, and mucilage, re-
peated every hour until bowels are freely acted on; cold affusion to
Harris's Cases of Epideinic Yellow Fever, 59
head, and cold cloths constantly applied to abdomeni acidulated bar-
ley water for diet and drink. H P- M, Bowels now operating
freely; tongue red at edges and furred brownish; pulse reduced to
120; pain in head, back and stomach, much relieved; urine of a deep
red; thirst great. Tepid bath, with cold affusion to head; ice in
small pieces allowed slowly to dissolve in the mouth; sponge body
with cold water every hour or two; repeat injection; continue barley
and iced water.
16//*, I to 7 A. M, Passed a restless and uncomfortable night; is
much reduced; head aches; bowels freely evacuated; tongue furred
brown in middle, and very red at edges and sides; slight pain of epi-
gastrium, increased on pressure; skin of abdomen hot; strongly so-
licits ice, and a repetition of bath with cold aff'usion; urine as last no-
ticed; pulse 110, and not so much force Two cups to epigastrium
and four to nape of neck, all of which drew well; repeat bath with
cold affusion; injection of cold mucilage; sponge body every hour
or two with whiskey; continue drink; repeat injection at 12 M.
9 P. M. Saw him during the day, but without material change;
pulse is now reduced to 100; head-ache absent, but to a dull sensa-
tion; complete evacuation of bowels; no pain of stomach; temperature
of skin lessened; tongue less furred and red; urine as last noticed.
Repeat bath with cold aff'usion, to be put in the bath without any
exertion on his part; if dullness of head continues, to have five
leeches behind each ear; a cool flaxseed mucilage injection; barley
and iced water continued.
17/A, 7 *d, M. Slept several hours last night; as dullness of
head decreased, did not apply the leeches; is very excitable; pulse
reduced to 90; skin assuming a disposition to slight moisture; urine
not so deep as last noticed; scarcely uneasiness in the head; tongue
becoming more natural; skin of abdomen rather excited; bowels open
and now yellowish; thirst much diminished; greatly prostrated.
Thin arrow root in addition to barley water, repeated every hour
or two; continue sponging abdomen with whiskey, and occasionally a
cool flaxseed mucilage injection. 85 P. M. About 12 o'clock this
morning slight sickness of stomach came on, which is now rather in-
creased than diminished, with a disposition to eructation; skin feels
pleasant over abdomen and body; pulse 85, and not far from natu-
ral; bowels open and yellow in colour. When sickness of stomach
came on, carb. sod. with tart, acid, in eff*ervescence, was occa-
sionally administered with but partial relief; much alarmed, and
greatly prostrated; (he has been made to use, as all the others were,
a bed -pan from the second day of attack.) Emplas. epispas. fort..
60 Harris's Cases of Epidemic Yellow Fever,
four bj six inches, to epigastrium; hot pediluvium with mustard;
arrow root every hour or two by tea-spoonfuls; flaxseed mucilage
injection.
18/A, 65 A, M. Epispastic has raised well, and has just been re-
moved; entirely relieved of sickness of stomach a few hours after it
was applied; tongue cleaning and good; every organ seems to be
doing its duty well; desires the juice of an orange, which was allowed.
Continue arrow root.
I9th^ 7 S.. M. Continues to do well; saw him last evening, but
without an additional observation; very slowly convalescing; desires
to eat. Continue arrow root.
9S)th, As last reported. Allow weak black tea and toast, and
chicken water occasionally by table-spoonfuls in the day.
21s/. Great desire to eat more; allowed a soft-boiled egg in addi-
tion for morning, and chicken soup through the day.
22(/. Is so well that he can sit up for a short time to-day. Conti-
nue regimen. From this day to the 24th he improved very rapidly,
and is enabled to walk about his room. Discharged, with restrictions
as to regimen.
Case XII. — Mr. J. T. set. about 26, sanguine temperament, full
habit of body, ordinary stature, first summer in New Orleans, was
seized this morning, September 14th, (four miles below the city,
where he slept every night, at the country-seat of Mr. L.) at 2
o'clock, with chilliness, pain in his bones, and sick stomach, follow-
ed by fever, head-ache, &c. ; his brother, who was with him gave him
§iss. of castor oil. I was sent for, but did not reach him until 10
o'clock, when the following observations were made. Pulse 140 and
full; is constipated; oil that he took has not acted; great heat and
pain increased on pressure of epigastrium; tongue furred in middle
and red at edges and sides; thirst for cold drinks intense; pain in
head very severe. Repeat ol. ricin. to be succeeded in two hours
by oil, molasses, and mucilage, as an injection, repeated every
hour until bowels are finally acted on; twelve cups to epigas-
trium and right and left hypochondrium, and six to lower part of
back, (they were applied by myself, as it would occupy' too much
time to send to the city,) they drew between xx. and ^xxiv. of
blood; this evening a tepid bath with cold affusion to head; repeti-
tion of injection also; barley and iced water in small quantity, and
often repeated.
15//i, 8i P. M, Bowels acted on eight or ten times since I saw
him; still head-ache; pulse 120, and less full; great diminution of
pain in epigastrium; tongue furred and red; urine of a deep red, and
Harris's Cases of Epidemic Yellow Fever, 61
depositing a lateritious sediment; diminution in temperature of body;
passed a restless night; thirst; was delighted with his cold affusion
and bath, (cold cloths were applied also after the cold affusion.)
Three cups to epigastrium; three to back of neck; warm bath
with cold affusion; cold flaxseed mucilage injection. This evening
at 9 o'clock repeat bath and affusion and injection.
16/A, 8| A. M, Pulse reduced to 100; tongue still covered with a
white fur, but less red at edges; urine not so deep a red; bowels
acted on several times in the night; a little sickness of stomach; no
pain of epigastrium on pressure; dull sensation in head; temperature
of skin improved; passed a restless night. Warm bath with cold
affusion to head; cool mucilage injection; carb. sod. with tart, acid
occasionally in effervescence; barley and iced water continued; if
dullness of head not relieved by 9 o'clock this evening, eight leeches
behind each ear.
17th, 8^ Jl. M. Passed a restless night, but slept two or three
hours; sometimes a little wandering when dozing; the leeches were
not well applied, and did not drav/ at all; stools darkish, and more
consistent than before; pulse 85; condition otherwise much improved^
is cheerful, and desires to eat something; no sickness of stomach;
temperature good; urine almost natural. A little thin arrow root
every hour or two; repeat injection of mucilage; continue cold drink,
although thirst not urgent; owing to the extreme solicitude for this
patient, I continued to visit him again at 5 P. M. when no change
for thfe worse had taken place. This evening at 9 o'clock a warm
pediluvium with mustard, and if any uneasiness of head comes on, a
cool mucilage injection; continue otherwise treatment.
18^A, 85 ./?. M. Slept several hours last night, and rested well;
no indication of wandering; tongue moist, and nearly clear; pulse 80;
skin good; does not complain; bowels open, and yellow; still desires
to eat. Continue treatment; to calm him and procure sleep this
evening if necessary, five drops of tinct. op. Rousseau.
19^A, 85 Ji- M. Slept several hours last night; took the tinct.
op. Rousseau about 12^ A. M. which composed him; was a little
restless previously; bowels open; skin good; tongue clean; does
not complain, except of very slight disposition to nausea; desires to
eat; thirst gone. Emplas. epispas. four by six inches to epigastrium,
to remain on for four or five hours; continue treatment. I left him
about 11 o'clock, and his brother came with me to the city, not
having left him before for any length of time during his illness; he
slept composedly during his absence; the brother returned about 3
o'clock, and found him tranquil and composed, but wishing his blister
No. XXVIL— xMay, 1834. 6
62 Harris's Cases of Epidemic Yellow Fever.
removed, which was done; all sickness of stomach removed; I left po-
sitive instructions if any change took place to have a messenger des-
patched forthwith for me.
On my visit of the 20th, same hour as the preceding days, I found
that his condition was hopeless, resulting from a violation of my di-
rection in permitting him to get up to stool; he fainted, and the injury
done was now too late to be repaired; his brother and a friend who
had gone down the afternoon previous were so deluded, that until my
arrival they considered him doing well; I found his pulse scarcely
perceptible; low muttering delirium; picking of the bed-clothes;
tongue and teeth, (sordes,) blackish; brandy injections were repeat-
edly given; and flying sinapisms to extremities; (deglutition was soon
lost;) the injury sustained was past renovation; he died at 12 o'clock;
a post mortem examination could not be effected.
Case XIII. — Mr. A. C. W. a merchant, second summer in New
Orleans, set. 26, sanguine-lymphatic temperament, the former most
developed, ordinary stature, was seized with chilliness, pain in bones,
sick stomach in the night, about 12i o'clock, September 16th, 1833.
I was sent for, but did not see him until 21 A. M. and found him in the
following condition: — Pulse 140, and full; costive habit of body; skin
hot; great sensibility of epigastrium on pressure; tongue red and tre-
mulous when projected; pain of head and lower part of back very
severe; ardent desire for cold drinks, particularly iced water.
Twelve cups to epigastrium, right and left hypochondrium; and
eight to lower part of spine; ol. ricini, ^iss. ; to be followed by injec-
tions of oil, molasses, and mucilage, every hour until bowels are
freely acted on; cloths dipped in cold iced water to head; iced barley
water, and water in small quantity at a time for diet and drink.
65 t^. M. Cups drew well, with much relief to head and back and
stomach; pain in head; tongue furred, and red at edges and sides;
bowels freely evacuated; pulse reduced to 115; urine of a deep red;
diminution of temperature in skin slight; sickness of stomach; thirst
continues, and cold drinks and application to head most grateful.
Repeat injection; tepid bath with cold affusion to head; continue
treatment, with addition of carb. sod. and tart, acid, occasionally in
eS'ervescence. 9 P. M. Saw him several times during the day, with-
out difference in observation; his bowels have been acted on four or
live times; head still aches; pulse 100; other condition as last noticed^
has been drowsy in the day; sickness of stomach relieved. Four cups
to nape of neck; warm bath with cold afifusion to head; a cool mu-
cilage injection; continue treatment.
I7th, 62 ,i, M. Head much relieved by thecups; pulse 90; tongue
Harris's Cases of Epidemic Yellow Fever. 63
a little less red at edges, but furred, as noticed, inclining to a brown-
ish-white| urine deposites abundantly a lateritious sediment; skin dis-
posed to moisture on forehead; slept two or three hours last night;
slight dullness of head, and nausea. Carb. sod. occasionally re-
peated; a cool mucilage injection; a warm bath; continue treatment.
9 P. M. Dulness in head still continues; sickness of stomach re-
lieved; bowels open; pulse and other appearances unaltered; except
a slight diminution in thirst. Two cups behind each ear; a warm
pediluvium; continue treatment; repeat injection. 1 remained to cup
him; while they v/ere applied the candle by accident set fire to the
mosquito-net, I instantly pulled it down and extinguished it, but it
so alarmed him that he sprang out of bed on the floor; he returned to
bed in a very short period, not so much agitated as I feared.
18^/i, 62 Jl, M. Passed a restless night until 2 o'clock this morn-
ing, after which he slept several hours; head aches, which is not so
severe as I dreaded; bowels open; forehead warm; tongue of a dark-
brown fur, with the papillae projecting through it; pulse in same state
as noticed; urine as deep in colour, without depositing sediment; no
sickness of stomach; skin warm over epigastrium. Eight leeches
behind each ear; warm bath with cold affusion to head; a cool mu-
cilage injection; continue treatment. 9 P. M. Paid several visits to
him in the day; head is entirely relieved by the leeches, &c. ; has slept
several hours; tongue less brown, and papillae not so projecting, edges
diminished in redness; urine not so deeply coloured; pulse 85; skin
nearly natural. A warm pediluvium with mustard, and at 8 o'clock
a cool flaxseed mucilage injection; continue treatment. Saw him
again at 9 P. M. but without any change for the worse, except a lit-
tle drowsiness; the injection was directed to be repeated.
19^^, 65 Jl. M. Rested well last night, yet a little drowsy; pulse
80; skin disposed to be perspirable or moist; tongue cleaning and im-
proving; urine approaching natural; thirst absent; desires to eat;
bowels open and yellowish. Thin arrow root, by tea-spoonfuls, every
hour or two; continue treatment.
2l5^, 7 J3. M. Continues to improve; saw him again last night;
desires urgently to eat. Allowed in addition weak black tea and a
small piece of toast; this afternoon chicken water.
22c?. Doing well; nourishment agreed well with him; desires this
morning a soft-boiled egg, which was allowed; chicken soup through
the day.
23(/ and 24th. Discharged well, with restrictions; is up in his room.
Case XIV. — Mr. C. H. H. a merchant, third summer in New
Orleans, set, about twenty-eight, sanguine-lymphatic temperament,
64 Harris's Cases of Epidemic Yellow Fever.
the former most developed, was seized, Wednesday, September 18th,
about 10 A. M. with chilliness, pain in bones and back, nausea, &c.
I was sent for, but being absent from the city, did not see him until
1 P. M. He had taken, about lOi o'clock, gjss. of castor oil. The
following observations were made when I saw him. Pulse upwards
of 140 and full; severe pain in head, lower part of back, and epigas-
trium; the latter much increased on pressure; skin hot; tongue red;
bowels constipated; thirst intense for cold drinks. Twelve cups
to epigastrium, right and left hypochondrium, and six to lower part
of back; ol. ricini repeated, to be succeeded by an injection of ol.
ricin. gij., molasses, §j., mucilage, §viij. mixed together, in two
hours, and repeated every hour until there are free discharges from
the intestines; cold cloths wrung out of ice water constantly applied
to head; iced water and barley water in small quantity, and often
repeated, for diet and drink. 8 P. M. Feels much relieved since
the application of the cups, which drew well; bowels evacuated four
or live times; still severe head-ache; pulse reduced to 120, and not
so full; is disposed to laugh constantly; tongue beginning to be furred;
urine of a deep red. Forbid all company except his nurse; a tepid
bath, with cold affusion to head; repeat injection; sponge body every
hour with whiskey; ice in gauze allowed slowly to dissolve in mouth,
otherwise continue drinks. Four cups to nape of neck.
19^^, 62 A, M. Passed a restless night; pulse 110; cups drew
well, and greatly relieved head; bowels open freely in the night; skin
reduced in temperature, and pain of epigastrium diminished on pres-
sure; tongue covered with a white fur and projecting papillae, and red
at edges; thirst not so intense; urine depositing a lateritious sedi-
ment; slight nausea; more tranquil, and assuming an usual appear-
ance from such symptoms. Soda pulv. with tart, acid occasion-
ally in effervescence; v>^arm bath with cold affusion to head; a cool
mucilage injection; continue treatment. 8 P. M. Saw him during
the day; pulse now 95; head relieved, excepting a dull uneasy sen-
sation; tongue very much furred; otherwise condition unchanged;
nausea relieved. Eight leeches behind each ear; repeat bath with cold
aff*usion; a cool mucilage injection; mass, ex hydrarg. grs. iv. nocte
et mane; continue treatment.
20M, \ to7 Ji> M. Head relieved; slept several hours last night;
pulse 85; no nausea; tongue assuming a brownish aspect, but papillae
much less projecting, and less redness at edges; several stools in the
night; skin disposed to moisture; urine pale and deposites less sedi-
ment; thirst less. A warm pediluvium with mustard; thin arrow
root by tea-spoonfuls every hour or two; continue barley water, and
Harris's Cases of Epidemic Yellow Fever. 65
the piece of an orange as it is desired. 8 P. M. Has had several
alvine discharges of a yellowish colour; tongue improving; condition
otherwise improving. Repeat cool flaxseed mucilage injection and
warm pediluvium with mustard; continue arrow root, &c.
Sllst^ 7 Jl. M. Slept several hours last night; pulse 80; skin good;
tongue still a little dark-coloured, but cleaning; urine nearly natural;
stools yellowish; thirst nearly gone. Continue treatment, increas-
ing the arrow root.
22of. Condition improving; desires to eat. Continue treatment.
236?. Tongue nearly natural; does not complain; desires to eat.
Allowed jelly in addition to his arrow root.
Mtlu Improving; his appetite greatly increased. Allowed black
tea with boiled milk and toast, and chicken water during the day.
25//i and SlGth. Chicken soup; a soft-boiled egg. Discharged well,
with cautions as to diet and regimen.
Case XV. — -Mr. J. V. a merchant. Frenchman, set. 36, first sum-
mer in New Orleans. I was requested to visit him in consultation
with Dr. Lacroix, Tuesday, September 17th, at 1 P. M. From Dr.
L. I learned that he had been taken with chilliness, pain in bones,
back, and epigastrium, succeeded by fever, on the Saturday previous.
When I saw him, the following observations were made. He had
suppression of urine since the previous afternoon; tongue deeply
furred with projecting red papillae, and red at edges; pulse 140, and
quick; bowels had been acted on by injections of Cassiafistularis; epigas-
trium hot and painful on pressure; pain and heat in region of blad-
der; no turgidity; slight pain in lower part of back; has been taking
table-spoonful of saline draught every hour or two since suppression
of urine came on; thirst; slight delirium. Four cups to left hypo-
gastric region, four to lower part of back, four to epigastrium; injec-
tion of ol. olivse, molasses, and mucilage; tepid bath with cold affu-
sion to head; mucilage sem. lini. with spts. nit. dulcis for drink; a
warm flaxseed poultice to hypogastric region after application of cups;
ked barley water, and ice in small pieces allowed slowly to dissolve
in the mouth.
18th, 7k A. M. Urinated freely last evening; pulse reduced to
110; redness of tongue lessened; bowels open; urine of a deep red
colour, (or brick;) no pain in epigastrium or lumbar region; tempe-
rature of skin diminished, as also thirst; no delirium; slept several
hours last night. Repeat bath with cold aftusion; a cool mucilage in-
jection; continue treatment. 4 P. M. Pulse 95; tongue less furred
and red; bowels open; otherwise no change in condition. A cool
.6*
66 Harris's Cases of Epidemic Yellew Fever.
mucilage injection; at 9 P. M. bathe feet in hot water; continue
treatment.
19//j, 7 Ji. M, Passed a restless night; pulse 90; skin but little
excited; urinates freely and much paler; tongue improved and cleaner;
his mind is disturbed in relation to his business, and a little flighty;
bowels open; thirst lessened. Cold affusion to head; a warm pedi-
luvium with the addition of mustard; a cool mucilage injection; ex-
clude company; five leeches behind ears. 8 P. M, Feels calm; no
flightiness after the affusion and leeches. Continue treatment.
20//i, 7\ Ji. M. Slept several hours last night; bowels open and
yellowish; pulse 80; tongue cleaning; skin disposed to moisture;
still a slight injection of eyes. A cool mucilage injection; thin arrow
root; continue treatment. 8 P. M. Slept several hours during the
day. A warm pediluvium, with mustard; repeat injection; continue
treatment.
9.1st, 7 ^. M. Slept several hours last night; all organs appear
to be performing their duty; tongue scarcely furred; bowels open
and yellowish; desires to eat. Continue treatment.
22c?. Doing well; black tea and toast, and chicken water through
the day.
23^. Appetite greatly increased; desires and allowed a soft-boiled
egg for morning, chicken soup through the day.
24^^. Is able to be up in his room; discharged with restrictions.
Case XVI. — Mr. J. S. P. set. 20, second summer in New Orleans,
sanguine-lymphatic temperament, was taken in the morning of Sep-
tember 25th, 1833, with chilliness, nausea, pain in bones, &c. This
was about 10 o'clock. I was sent for, but did not, (owing to ab-
sence,) visit him until 1 P. M. w^hen I found him covered up with
thick blankets, (although a hot day,) and in a forced profuse perspira-
tion; severe pain in head, lower part of back and epigastrium, the
latter increased on pressure; tongue tremulous and red; skin hot;
pulse 140, and full; bowels constipated; considerably agitated; great
thirst. The covering directed to be removed, so as not too suddenly
to check transpiration; warm or tepid lemonade occasionally for
drink; ol. ricin. giss. to be succeeded every two hours by injections
of oil, molasses, and mucilage, until al vine discharges are freely pro-
duced; ten cups to epigastrium, right and left hypochondrium, four
to lower part of back. 8 P. M. Owing to the injection pipe not be-
ing sufficiently large, the injections have not had the desired effect;
bowels have only been once acted on; much relief of head, back, and
epigastrium; pulse 120; tongue beginning to be furred; urine ©f a deep
Harris's Cases of Epidemic Yellow Fever. 67
red colouri skin warm; perspiration gradually declined; thirst as
above. Repeat injection as directed; tepid bath, with cold affusion
to head; ol. ricin. 5j.; cold barley water for diet and drink; sponge
body every two or three hours during night with whiskey.
26//i, 6i ^. M. Passed a restless night; bowels freely opened;
;pulse 100, and not so full; temperature of skin much reduced; tongue
covered with a white fur, (papillae red and projecting,) red at edges;
urine as noticed, and depositing a lateritious sediment; slight nausea;
thirst not so intense; pain in head, back, and epigastrium absent, ex-
cept a dull sensation in head; skin of forehead hot. Tepid bath,
with cold affusion to head; repeat injection; sponge body every hour
or two with whiskey; ice slowly allowed to dissolve in mouth, and if
dullness of head continues to 12 M. four cups to nape of neck; carb,
soda with tart, acid in effervescence occasionally; continue treat-
ment. 8 P. M. Saw him since last report; head so much relieved, that
the cups were not applied; pulse 95; skin rather warm; sickness of
stomach removed; bowels entirely free; other symptoms not mate-
rially varied. Warm bath, with cold afiusion to head; cold mu-
cilage injection; continue occasional sponging; continue treatment.
27//i, 6§ Jl. M. Slept several hours last night; pulse 90; injection
passed soon after its administration; skin less hot, and slightly dis-
posed to moisture on forehead; tongue furred, but papillae less pro-
jecting, and not so red at edges; urine as noticed; thirst much de-
creased. Repeat cold mucilage injection; a warm pediluvium; thin
arrow root by tea-spoonfuls. 8 P. M. But little change since last
visit; bowels open and discharge yellowish. Repeat injection; add
mustard to pediluvium, and repeat it; occasional sponging continued 5
continue treatment.
28//i, 65 A. M. Slept several hours last night; pulse reduced to
85; skin pleasant to touch; tongue improving; bowels open; urine im-
proving fast; thirst nearly absent. Continue treatment.
29^/t. Tongue nearly natural; all organs seem to be regaining their
normal action; pulse 80; slept well; desires to eat. Chicken water,
and continue treatment.
Was discharged well October 1st.
Case XVII. — Mr. S. set. 30, sanguine temperament, second sum-
mer in New Orleans, was taken October 5th, 1833, v/ith chillinessj
pain in bones, back, and epigastrium, succeeded by fever, head-ache?
&c. Dr. Barton saw him a few hours after attack, and detracted
blood to the amount of twenty-four or thirty ounces by the lanceti
ordered injections of ol. ricin,, molasses and mucilage, every two or
three hours, until bowels were freely acted on, (they were consti-
68 Harrises Cases of Epidemic Yellow Fever.
pated;) cold to head; barley water for diet and drink. Dr. B. having
to be absent from the city for a week, requested my attendance upon
him.
Oct, 6th, 7 P. M. I found him in the following state:— Pulse 120:
bowels freely acted on; pain of epigastrium slight on pressure; abdo-
men and skin hot; intense pain in head; tongue furred, and red at
edges; eyes injected; thirst great; urine of a deep red, and deposit-
ing a lateritious sediment. Repeat injection; tepid bath, with cold
affusion to head; sponge body during the night every hour or two
with whiskey, and should head still continue painful after the affu-
sion, eight leeches behind each ear; ice in small pieces allowed slowly
to dissolve in mouth, in addition to cold barley water.
7tli, 7 Ji. M. After the bath and affusion, he was so much relieved,
that the leeches were not applied; slept several hours; pulse reduced
to 90; skin much improved, and not far from natural; bowels freely
opened; fur of tongue a little blackish in the centre; thirst greatly
diminished; no pain in epigastrium; otherwise unchanged. A cold
mucilage injection; occasional sponging; continue treatment. 6 P, M.
Condition but little varied since morning, except now a slight pain
in the head. Kepeat bath, with cold affusion; occasional sponging
continued; continue treatment.
8^/i, 7 ^. M. Passed a restless night; appearance improved; other-
wise no excitement felt; pulse 80; a little sickness of stomach, the
consequence of neglect of his attendants permitting some exertion
when getting out of the bathing-tub, which brought on syncope; tongue
but little changed in colour in centre, but redness of edges neverthe-
less; bowels open; urine deposits less sediment, and more pale; not
much thirst; skin good. A sod. pulv. with tart, acid occasionally
in effervescence; a warm pediluv. with mustard; a cool mucilage in-
jection; desired and allowed the juice of an orange; continue barley
water. 6 P. M. No sickness of stomach; tongue improved, and be-
ginning to clean; does not complain. Continue treatment.
^th, 7 A. M, Slept well; desires to sit up, but forbid; all organs
fast assuming their normal actions. Continue treatment.
lO^A, 7 Ji. M, Continues to improve; desires to eat, allowed arrow
i-oot in small quantity at a time.
11/A. Tongue clean; bowels open and yellowish evacuations; con-
valescent; allow chicken water.
\9ih. Continues to improve; appetite greatly increased. Chicken
soup in the day, black tea and toast for morning.
\^ih. Discharged well.
Case XVIIL — Mr. H. set. 30, sanguine-lymphatic temperament,
Hdsvh^s Cases of Epidemic Yellow Fever. 69
second summer in New Orleans, an intimate friend of mine, was
seized about 6 P. M. August 26th, 1833, with chilliness, pain in
bones, lower part of back and epigastrium, succeeded by fever, &c.
I was sent for, and saw him about 9 P. M. when he presented the
following symptoms: — Fain in head, back, and epigastrium, the latter
increased on pressure^ pulse 140, and fall; skin hot, particularly over
abdomen; bowels constipated; great desire for cold drinks; tongue
red and tremulous. Twelve cups to epigastrium, right and left
hypochondrium, six to lower part of back; ol. ricin. §iss. to be suc-
ceeded in two hours by injections of oil, molasses, and mucilage, re-
peated every hour until bowels are freely acted on; cold afiusion to
head; cold barley water, and iced water for drink in small quantity
at a time, but often as desired.
27^/i, 6| A. M. Passed a restless night; bowels freely acted on^
pulse 120, but less full; pain of epigastrium, head and back, greatly
relieved; nausea; urine red, and deposites a lateritious sediment;
tongue furred and red at edges; the eyes injected; cups drew wen<j
(about gxvi. of blood;) heat of abdomen and thirst but little varied.
Repeat injection; tepid bath with cold aftusion to head, and cold
cloths afterwards constantly applied to epigastrium and head, other-
wise continue treatment, (except in addition carb. sod. with tart,
acid, in effervescence, occasionally repeated.) 12 M Nausea rather
increased; bowels freely opened; pain on pressing epigastrium; skin
hot. A cold mucilage injection; three cups to epigastrium; continue
treatment. 9 P. M. Pulse reduced to 100; sickness of stomach much
relieved; yet head-ache; other symptoms but little changed. Repeat
cold injection; warm bath with ailFusion of iced water to head; sponge
body every hour or two with whiskey; continue treatment.
28//i, 6 Jl. M. Again passed a very restless night; was much re-
lieved after the atfusion and bath, and calls for its repetition; bowels
open; pulse 95; skin much reduced in temperature; thirst not so in-
tense; other symptoms as noticed; head aches much less. Con-
tinue sponging! repeat injection and bath, with cold affusion; conti-
nue iced barley water and water; desires of being allowed to alter-
nate his drink with orangeade. 9 P. M\ Much prostrated; pulse 90;
does not complain but of dullness of the head; slept about an hour
during the day; urine (and tongue not so deeply red, and furred a lit-
tle brown) less deep in colour; eyes slightly injected, and a little
wayward in appearance; bowels open; temperature of skin improved,
but no disposition to moisture; thirst increased; but little nausea.
.Eepeat cold mucilage injection; warm bath with cold affusion; four
70 Harris's Cases of Epidemic Yellow Fever.
leeches behind each ear^ continue sponging every two or three hours
in the night; continue treatment.
29//2, 6 A. M. Slept several hours last night, and felt entirely re-
lieved; tongue is less brown and red, and evincing a disposition to
clean; no uneasiness in head; bowels open and yellowish; pulse 85,
but weak; temperature nearly natural; urine deposites scarcely any
sediment; no injection of the eyes, and complains only of a little
nausea; disposed to sleep this morning; thirst almost absent; de-
sires the juice of an orange, which was allowed. Sod. pulv. in ef-
fervescence, when much nausea; a warm pediluvium about 9 A. M.
Continue treatment. 9 P. M. Saw him during the day, but without
difference in observation; nausea; pulse 80; bowels open; no pain on
pressing epigastrium. Emplas. epispas. four inches square to epigas-
trium, to remain on until morning, unless nausea is sooner relieved;
in this event, to remove it in four or five hours; mucilage injection;
repeat pediluvium, with the addition of mustard; continue barley
water.
QQth. Epispastic soon relieved nausea; it was therefore removed,
and dressed with cerate, after which he slept several hours; tongue
cleaning; bowels open and discharge yellow; skin good; urine almost
natural; pulse feeble; does not complain. Thin arrow root every hour
or two; continue barley water.
From this time to September 4th, he continued very slowly to con-
valesce; he now desires to eat something else, and chicken vs^ater
is allowed.
5th. Appetite and strength fast increasing; allow chicken soup in
the day; black tea and toast for morning.
6/A. Fast improving; desires and allowed an egg.
7th. Discharged well, with restrictions as to regimen.
Case XIX. — Mademoiselle -, set. 16, a Creole of the city, but
educated for the last seven or eight years in France, returned home in
December last: temperament sanguine-lymphatic, ordinary stature,
has menstruated for the last two years, was seized, August 24th,
1833, about 12 M. with rigors, pain in epigastrium and bones, par-
ticularly lower part of back, succeeded by head-ache, fever, &c.; her
menses should have appeared the day previous, but no indication was
presented. I was called at 6 P. M. when the following observations
were made. Pulse 130 and full; pain of head, epigastrium, andlower
part of back; the pain of epigastrium increased on pressure; skin hot,
particularly over abdomen; tongue red; eyes injected a little; bowels
constipated; constant desire for cold drinlis. Forty leeches to.epi«
Harris's Cases of Epidemic Yellow Fever. 71
gastrium; ol. ricin. §i., to be succeeded bjan injection of ol. ricin.,
molasses, and mucilage in two hours, to be repeated every two hours
until free discharges from intestines take places a tepid hip-bathj cold
barley water for diet and drink.
25//i, 6 A, M. Passed a restless night, v/ith but little sleep; pulse
reduced to 115| bowels freely opened; pain in head, back, and epi-
gastrium much relieved by the leeches, which drew well; urine now
of a deep red, and deposites a lateritious sediment; tongue furred,
white, and red at edges; temperature of skin diminished; eyes much
less injected; thirst great. Repeat injection; tepid bath with cold
affusion to head; sponge the body every hour or two with whiskey;
ice allowed slowly to dissolve in mouth; continue treatment. 9
P. M. Saw her during the day, but no material variation; pulse
now 110; desired repetition of the bath and affusion; head still
aches, and slight pain of epigastrium; bowels freely evacuated, (five
or six times in the day;) eyes scarcely injected; other symptoms as
noticed. Ten leeches to epigastrium; a cool mucilage injection; re-
peat bath with affusion; continue treatment.
26jfA, 6 .^. M. Passed a less uncomfortable night than the preced-
ing, having slept two or three hours; only complains of dullness in
the head; no pain in epigastrium, and skin much reduced in tempera-
ture; pulse 100; bowels open; tongue not so red at edges, but furred9
slightly brownish; thirst not so great; urine of a paler red, and depo-
sites not so abundant. Sixteen leeches to inside of thighs; continue
treatment. 8 P. M. Feels entire relief of the head; complains of
nausea since 12 M.; other symptoms as noticed, except pulse, 90.
Carb. sod. with tart acid, in effervescence, every hour or two, while
nausea continues; a warm pediluvium; continue treatment.
27^/i, 6^ A. M. Passed a comfortable night; does not complain |
pulse 80; skin good; thirst nearly absent; tongue showing a disposi-
tion to clean; is much prostrated and reduced; all appearances good;
slight appearance of her catamenia. Thin arrow root every hour or
two, in small quantity at a time; desires orangeade, which is allowed.
28^/i. Saw her several times yesterday; tongue cleaning; appetite
increasing; bowels open and yellowish. Continue treatment.
29^/i. Slight nausea came on this morning, owing to an attempt to
be elevated in bed, but now has nearly disappeared. Continue
treatment.
30//«. All nausea gone; desires to eat; allow chicken water. From
this date to September 4th, she very gradually improved in strength.
Now chicken soup, and a soft-boiled egg was allowed, the latter with
black tea and toast in the morning.
72 Harris's Cases of Epidemic Yellow Fever,
6th. Is enabled to be up in her room. Discharged with restrictions.
Case XX. — The following case presents in the strongest light the
truths of physiological medicine. Mr. J. N. H. a merchant, and par-
ticular friend of an intimate professional friend of mine, the latter
of whom was taken ill and absent from the citj. Mr. H. was of san-
guine temperament; corpulent habit of body; first summer in the city;
aet. about 33. He was affected with the ordinary premonitions of
fever, in the night of September 7th, 1833. I was sent for, but the
messenger procured another physician. On the night of the 12th of
the same month, his friends came imploring me to visit him, as his
condition, to use their expression, was hopeless. They had taken
upon themselves the responsibility, and left the case, if I would see
him, entirely under my guidance. This was at 11 P. M. When I
saw him, I requested Dr. Hunt to be called, and, in conjunction, we
would attend him, though with extreme reluctance, on account of
public prejudice and public excitement. I learned that he had been
treated, from the first commencement of the attack, with calomel,
charcoal, and pulv. nit. potassse, in combination, Seidlitz powders,
porter, &c. The powders of calomel, &c. I found were still being
administered to him, together with the above articles. At this time
we noticed his condition as follows: — Convulsive hiccoughs; mind
much disturbed, and wandering delirium; discharges of charcoal from
the intestines every fifteen or twenty minutes; continually crying,
and momentarily expects his dissolution; skin cool; fulness of abdo-
men; pulse small and tremulous; irritability of stomach; tongue red
at edges; thirst considerable, and heat of stomach. Discontinue all
previous treatment, and substitute the following. Epispas. ten inches
square, to abdomen; cold barley and iced water for drink. In the
morning, about 2 o'clock, we were aroused by there having been
constant purging, since we left, of the above-described character.
We prescribed syrup morphia, which fortunately checked the dis-
charges, and calmed his great nervous excitability.
8th, 12 M Slept, but disturbed an hour or two after our visit;
rambling and delirium continue; epispastic drew well, produced
strangury; complains of intense heat; hiccough continues, and acid
eructations all morning, and one fit of black vomit about half an hour
since, and is preserved on a napkin; the hiccoughs convulse him.
Three cups to nape of neck, and administered ourselves a warm
bath with iced affusion to head; ice in small pieces allowed slowly to
dissolve in mouth; continue barley water. Solut. of hyd. bismuth,
table-spoonful every hour or two, so long as eructation continues.
8 F. M. Condition but little changed; bowels have been opened
Harris's Cases of Epidemic Yellow Fever, 73
two or three times to-day, of same character as abovej desires a repe-
tition of his bath and affusion, which was most grateful to him; dis-
charge of urine constantly by drops; no more black vomit. Eight
leeches behind each ear; repeat bath and affusion; cool mucilage in-
jection; continue treatment, with the addition of a tea-spoonful of
thin arrow root occasionally.
Q^A, ^ Ji, M. Black discharges have occasionally taken place
during the night from the intestines; hiccough continues, but less con-
vulsing; delirium less; mind more calm; company has been ordered
to be excluded ever since we have seen him; expresses his delight
at the sensation of relief produced by the cold affusion. Cool
mucilage injection; repeat bath and cold affusion; continue treatment.
8 P. M, Saw him several times during the day; getting more tran-
quil; black discharges less frequent and less deep colour; hiccough,
but rather less frequent and much less convulsing; thirst not so intense;
head not entirely relieved; urinates rather more freely. Repeat bath
and affusion; continue treatment; occasionally the solution of bis-
muth.
10/A, Q A. M. Rested several hours last night; hiccough disap-
pearing; sensation of heat fast vanishing; head as last reported
Cool mucilage injection repeated; ice to head to be discontinued
when uncomfortable to feelings; continue treatment.
llth^ 6 .^. M. Saw him several times yesterday, and the forepart
of the last night; the ice to head was discontinued in two or three
hours from its application; hiccough nearly ceased; all evidence of ir-
ritation absent; urinates well; is tranquil; discharges from bowels be-
gin to assume a natural appearance, (yellowish.) Continue treatment;
barley water and arrow root. 4 P. M, Hiccough gone; is cheerful;
pulse good; no wandering; continue arrow root and barley water. 8
P. M, Company in our absence have intruded, and conversed with
him on business transactions, which has produced symptoms threat-
ening more than ever his dissolution; he has parching thirst; ex-
tremities cool; pulse quick and feeble; tongue red| delirium. Epis-
pastic to nape of neck; a cool mucilage injection; continue treatment.
2 A. M, We were aroused from bed, and found him exceedingly
restless, tossing in every direction in bed; such was the condition of
his mind, that we feared to let him see us at that hour of the night, but
unobserved by him we prescribed a cool mucilage injection; a warm
pediluvium with mustard; and the epispastic to be removed and dress-
ed, it had drawn well.
12^^, 6 A. M. Got more calm after the above directions were
executed, and dosed for an hour or two; is now more quiet;
No. XXVIL— May, 1834. 7
74 Charlton's Cases of Gastritis.
delirium greatly abated, &c. pulse weak; extremities improved id
temperature; thirst diminished greatly; discharges from intestines
yellowish. Injection of weak beef tea every two or three hours; ice
in mouth. 8 P. M. Saw him several times during the day; appear-
ance has been fast improving; has become entirely calm; no wander-
ing. Injection of beef tea repeated; a warm pediluvium with mustard;
thin arrow root occasionally.
13/A, 6 Jl. M. Rested and slept calmly several hours last night,
is again cheerful and free from any trace of irritation. Allow a
little jelly occasionally through the day. From this date to 19th
his nourishment was gradually made more nutritious and increased^
and is on last date enabled to be up in his room,
9.0th. Discharged well.
New Orleans J January, 1834.
Art. III. Cases of Gastritis Superinduced. By Thomas J. Charlto%
M. D. of Georgia.
JL HE physiological practice is entitled not only to the positive merit
of curing disease, but also to the no less important negative one of
preventing the use of injurious and empirical remedies. In truths
when we remark the delicate structure of the mucous membrane of
the primae vise, and the essential nature of their normal condition to
health and vitality, and at the same time reflect what improper and
corrosive substances were lavishly placed in contact with it, we
can scarcely refrain from asserting that in very many cases the dis-
ease was less dangerous than the physician. Most especially in the
fevers of warm countries has this membrane suffered from injudi-
cious treatment; the more intense its inflammation the more indus-
triously was this added to by tonics and diffusible stimuli, and when
by these means it approached disorganization, evincing itself by the
black tongue, cold skin, and the debility, it was said to be reaching its
ultimatum, and to be only remediable by the most profuse administra-
tion of the most powerful excitants. Is it wonderful that the sup-
posed typhus state of fever, was common and fatal under a modus
medendi, as rational as that which in Turkey loads the sufferer from
small-pox with warm clothing, applies hot plasters to the eruption^
and diets him on hot caviare?
The truth of the inferences which the able founders of the physio-
Charlton's Cases of Gastriiis. 15
logical school have drawn, not only from the fallible, (and heretofore
principal basis of medical systems, ) ontology, but also from numer-
ous and minute post mortem examinations, will eventually carry
conviction to all minds sufficiently candid to reject error when con-
vinced of it, however fatal such rejections may be to favourite theories.
Broussais' works are already in the hands of nearly every intelligent
physician of our country, and the plan of treatment inculcated in
them is becoming established in chronic disease of the viscera, but those
of an acute character are still frequently subjected to the '' incendiary
practice," and as long as this is the case, it is the duty of every me-
dical practitioner to furnish such facts as may have occurred to him,
leaving the inferences to the candour and discrimination of the profes-
sion. It is with this view that I offer for publication the following cases
taken from many others of a similar character, and equally conclusive.
Francis Demere, nine years old, had been attacked with the usual
symptoms of climate fever, five days before I saw him; being at some
distance from medical aid, he was treated by his parents. On the
second day a cathartic was given, which increased the nausea and
vomiting, which had existed from the onset; another M^as given on
the third day, with the same effect, and from the continuance of this
symptom he was supposed to be suffering from a redundancy of bile,
and that an emetic was indicated; one grain of tartar emetic was ad-
ministered, which increased the distress and nausea, but did not
cause much vomiting; all his symptoms became worse, and when I
saw him, (12th August,) his pulse was small, and 125 a minute; his
skin very cold; complexion palled; and the tongue brown; I recog-
nised gastritis, and ordered blisters to his extremities, and small
quantities of gum water, acidulated with orange juice for drink; the
tongue in six hours became cleaner, the skin warmer, and the pulse
fuller and slower; but at the accession of the cold stage of the nest
paroxysm, (the type was double tertian,) the debility appeared so
urgent that I was induced to give a tea-spoonful of wine «very fifteen
minutes; this stimulant evidently increased the gastritis, the tongue
became dark again, the skin cold, and at the same time there was in-
tense suffering from internal heat, and an urgent demand for cold
drinks. I determined to resume and adhere to the plan of treatment
first adopted; at each accession of the paroxysms I endeavoured to
sustain the system by the application of mustard plasters to the ab-
domen and extremities, and during the paroxysm I gave the gum
Arabic water and lemonade. I was gratified by seeing the evidences
of gastritis slowly subside, and by a gradual resumption of food, the
patient acquired his usyal health.
76 Dudley on Congestive Fever.
The next case I have selected is that of a negro. Catherine, twenty
years old, had been attacked with pleurisy seven days before I saw
her; she had been bled, but not sufficiently, and had taken a cathartic
and two emetics of the sulphas zinci; when I saw her, gastritis had
been superinduced, her pulse was quick and small, there was great
distress and oppression in the epigastrium, the tongue was dark, and
she was comatose when not roused. The cough was not troublesome,
the expectoration was copious, and iho, respiratory murmur as dis-
tinct as usual, there was no evidence of etfusion in the thorax. Be-
lieving her to be suffering more from mal-practice than from the ori-
ginal disease, I directed my efforts to the purpose of subduing the
gastric irritation which I attribute to the emetics. I cupped her over
the epigastrium, and gave her small quantities of flaxseed mucilage
cold frequently. The disordered intelligence soon improved, and the
tongue became clean; but having indulged in the use of food at night,
all her symptoms became worse, and her disease appeared to be ap-
proaching a fatal termination. I directed blisters to the legs and
abdomen, purgative enemata and gum Arabic water. The termina-
tion of her disease was long doubtful, but she eventually recovered
by a persistence in the use of mucilages and a rigid diet.
Bryan County, Georgia, January 15th, 1834.
Art. IV. Thoughts on the Bilious Remittent, commonly called Con-
gestive Fever, By Theodore Bland Dudley, of Alexandria,
Louisiana.
OOME one has said quaintly, but forcibly, that "words are the
counters of wise men, but money of fools." It is much to be
lamented, that in medicine, as well as in religion and politics,
there should be so much of fanaticism prevail; words or names
are substituted for things, and reasoning in a specious but delu-
sive garb, often misleads even those who are most proud of assent-
ing to nothing that is not sanctioned by its dictates. Why else is it,
that some favourite dogma in our science, from the days of Paracel-
sus to the present time, always has its day? Sangrado with his
warm water; Brown with brandy and opium; Rush with his lancet;
to a host of minor luminaries, with their drachms of calomel, which
they unceasingly pour down without scruple.
These reflections have grown out of the present prevailing notion,
Dudley on Congestive Fever, 77
that calomel, and calomel alone, should be our sole reliance in the
treatment of the various grades of remittent fever of southern cli-
mates. It is a Samson indeed, and its strength may be applied to
useful and salutary purposes; but that does not vi^arrant, in the eye
of dispassionate and philosophical reasoning, the tearing down the
temple, to the utter destruction of the edifice and its inmates.
The mode of reasoning of the advocates of this Herculean system
is simply this, that in a certain form of fever commonly called con-
gestive, there is an engorged state of that complex and important
organ called the liver, whose office is the secretion of bile, so essen-
tial to the healthy action of the animal economy — that calomel having
a more decided specific action on that organ than any other known
^gent, it must be given ad infinitum, till the liver is brought into
subjection, and a healthy performance of its functions. This is plau-
sible reasoning, and would be valid enough, if the fact be admitted,
that it will generally produce the desired result without any con-
comitant evils; and it were equally well established, (as they as-
sume,) that there are no other agents, which alone, and especially as
adjunct to the mercurial system moderately enforced, will produce
the desired result without its concomitant evils.
The theory that the mercurial fever is essential to subduing that
already existing^ is, I think, toto coelo, fallacious. It has arisen from
the fact, that in particular grades of morbid excitement in this con-
gestive fever, when salivation is induced, the patient becomes con-
valescent; it is inferred from a very common, but fallacious mode of
reasoning, (the placing effect for cause, and vice versa,) that saliva-
tion is essential to cure. But I believe that in every instance, where
this state of things results, the same effect would have ensued from a
much more simple and harmless procedure, the evacuant and sedative
course; convalescence is more speedy, and the horrible consequences
that occur when salivation cannot be induced, viz. mercurial gan-
grene often, and chronic mercurial disease generally would be ob-
viated. I have witnessed in numerous cases the most shocking and
deplorable consequences from this pernicious abuse of mercurials, the
patient dying by inches, an object of the most intense and agonizing
sympathy to the friends, and of loathing and hoi-ror to the spectator,
of hopeless wretchedness.
The autumnal remittent, commonly called congestive fever, as it
usually prevails in the southern part of the United States, and espe-
.cially on Red River, where the writer of this article has seen and
marked its character, commonly commences with the usual precur-
,sor9 of fever— languor; lassitude; indisposition to action; loss of appe-
.7*
78 Dudley on Congestive Fevef.
tite; chill, not always distinctly sensible to the patient, but with,
evident shrinking of the extremities, followed by febrile paroxysm,
more or less sensibly developed^ yellow discoloration of the skin, and
especially of the conjunctive coat of the eye. The patient for seve-
ral days is able to go about, but finally confined by aggravation of all
symptoms. Excessive irritability of stomach now comes on, accom-
panied by torpor of the bowels, which are with difficulty moved by
ordinary cathartics. During the cold stage, which often continues
from four to six hours, the irritability of stomach is greatly aggra-
vated, and is indeed one of the most distressing and uncontrollable
symptoms of the disease. The pulse is feeble and thready, not much,
increased in frequency, and greatly diminished in volume. The
tongue is furred, and of various colours, from light brown to a dark
inky hue 5 generally moist.
If this state of things is not met with promptitude and energy,
there is a rapid decline of all the vital powers, and the patient dies
on the seventh, ninth, or eleventh days. The disease invariably as-
sumes the tertian type, the paroxysms being more violent on the al-
ternate days5 there is however a daily chill, which on the odd, or
critical days, is greatly aggravated.
The indications of cure are obviously to equalize action, to ab-
stract from organs most labouring under a suffocated state of excite-
ment, and to invite action to those parts where there is an evident
deficiency. With this view during the remissions, it is desirable to
produce a prompt action on the bowels by cathartics, and of this
class of medicines, I have found calomel combined with rhubarb
alone, and sometimes with aloes, as in the following prescriptions,
the most efMcient. R. Merc. mit. gr. x. vel xij.5 pulv. rhsei, 9j.
Or the following: — R. Merc, mit., pulv. rhaei, pulv. aloes socot. aa.
gr. X. M. ft. pill, vel bolus. In from three to six hours, should
there be no decided effect on the bowels, give an active dose of castor
oil, and should this fail, cathartic enemata should be freely adminis-
tered, till the desired effect be produced. During the hot stage, the
free use of saline diaphoretics has the happiest effects in counter-
acting the unequal distribution of the excitement, tending to an evi-
dent mitigation of all the violent symptoms^ as soon as diaphoresis
manifests itself, with this view, whenever the hot stage is decidedly
developed, unaccompanied by irritability of stomach and vomiting,
the following prescription will prove highly beneficial. R. Antimon.
tart. gr. j.j pulv. nitri. Jss.; aq. font. ^vi. M. ft. mist. A table-
spoonful to be given every hour till free perspiration supervene.
Should the inflammatory action run high, and the above prescription
Dudley on Congestive Fever, 79
fail to produce the desired effect, the lancet should be called into its
aid. But should there be great irritability of stomach, as is often
the case, the following prescription should be substituted. R. Carb.
potassae, gr. x.j aq. font, ^j.^ succ. limon. q. s. ad ejus saturatio-
nem — ^quaque hora adhibenda donee supervenirit diaphoresis.
Should this fail to allay the irritability and vomiting, apply a large
blistering plaster over the region of the liver and stomach, and recur
again to the purgative enemata, either of which remedies alone has
the happiest effects in arresting vomiting, and relieving the sensation
of anxiety and oppression, which are in most cases horribly severe.
In this state of things the patient often complains of intense burn-
ing sensations, and anxiously beseeches the use of the fan to produce
ventilation; when the parts so complained of are greatly below the
natural temperature; when the extremities are cold, and the general
temperature of the body is below the healthy standard.
During the existence of this stage of the disease, so distressing to
the patient, (for this is the period of greatest anxiety and suffering,)
I have found the semicuprium followed by frictions, with a warm in-
fusion of Cayenne pepper in brandy, to act most powerfully in pro-
ducing revulsion: sometimes sinapisms or blistering are necessary to
keep up a permanent impression: often hot bricks or bladders, or bot-
tles filled with hot water, will have the desired effect.
There is always a marked alleviation of all the urgent symptoms of
this fever as soon as free alvine evacuations are produced, which ex-
hibit in colour and consistence almost every variety of shade. Some-
times in milder cases simple bilious discharges are produced, and
such cases are soon brought to a favourable crisis, by keeping a con-
stant eye to the free evacuation of the bowels during the remissions,
and the use of the saline diaphoretics above-mentioned during the fe-
brile paroxysms; but in other cases of aggravated forms of the dis-
ease, this desideratum is with difiiculty obtained. There seems to be
so great an accumulation of morbid secretions producing torpor of the
bowels, that the most active cathartics appear feeble and inefficient;
in this state the exhibition of active cathartic enemata as adjuvants is
attended with the happiest and most decided good effects.
The writer has witnessed cases where the degree of exhaustion was
so great that the patients had become pulseless, and all the ordinary
precursors of approaching dissolution were rapidly developing them-
selves. When the exhibition of strong purgative enemata has been re-
sorted to, bringing away copious acrid, vitiated secretions, there has
been a return of pulse, and an increased strength and fulness after
80 Mutter's Instrument for Operating in Fistula in *^no.
each discharge, and this in cases too, where a timid and cautious
practitioner would dread exhaustion from purgation.
Whenever local congestions exist, cupping and leeching are highly
salutary — the pulse becoming slower and fuller, even after a very
small abstraction of blood has taken place. As soon as this happy re-
sult occurs, viz. a more generally diffused state of the excitement, a
remission of all the urgent symptoms immediately follows, and con-
valescence is speedily established, which requires little further to
complete the cure than a due attention to the state of the bowels, and
a strict regard to diet.
Art. V. An Account of a New Instrument for Operating in Cases
of Fistula in Ano. By Tkomas D. Mutter, M. D. one of the
Physicians to the Philadelphia Dispensary, &c.
Jr ROM the time of Hifpo crates down to the present day, no disease
has excited more attention, and been studied with more success, than
the one termed, (though very incorrectly in most cases,) fistula in
ano: its causes, its phenomena, the indications to be fulfilled in its
management, have all been clearly and positively demonstrated; it
would therefore be worse than useless for us to enter, at this late
period, into an elaborate history of the disease. It will be neces-
sary, hov/ever, to notice the usual divisions of fistulas, in order to
render apparent the design and modus operandi of the instrument
about to be described. When a discharge by incision of the contents
of an abscess situated in the neighbourhood of the rectum has been
too long delayed, the matter will of its own accord force for itself
an opening, either through the external parts in the neighbourhood of
the anus, or through the parietes of the rectum. Occasionally it
happens, that we have both an internal and external orifice, existing
at one and the same time. These different conditions have given rise
to a division of anal fistulse into three species— 1st, those in which
the matter escapes by one or more openings through the integuments
alone, and which are called ''blind external fistulssj" 2d, those in
which the matter empties into the cavity of the rectum, and no ex-
ternal opening exists, which are called "blind internal;" and 3d,
those in which an opening exists both in the gut and skin, which are
termed <' complete fistulae." Notwithstanding the assertion of MM«
Mutter's Instrument for Operating in Fistula inJino. 81
FouBERT and Ribes, and to which opinion Sabatier inclines, " that
no such thing as a blind external fistulas can exist, and that in all
cases there is an opening into the gut," both experience and reason
lead us to contend, that so far from this state of things never occur-
ring, it is the most common variety of fistula in ano^ and this I be-
lieve is the opinion of the most experienced surgeons of the present
day. The difficulty with which a sinuous ulcer, when located in loose
cellular tissue, heals, has long been fully appreciated, and numerous
methods of effecting this end have been introduced into practice;
caustics, stimulating applications, incision, extirpation, &c. have all
been tried at different periods, and with varying success. The father
of medicine long ago taught this fact, and to him are we indebted for
the very measures made use of at {he present day in the treatment of
fistulse, though modified it is true, both as regards the cases to which
they are applied, and the instruments employed. The indication to
be observed in the treatment of fistula in ano, (a disease belonging
to the class of *' sinuous ulcers situated in loose cellular tissue,") is
the division of the barrier existing between the sinus and the cavity
of the gut, and formed chiefly by the walls of the latter, by which
means the two cavities will be thrown into one, and an open sore,
instead of a hollow sinuous one, established.
The ancients were fully aware of the importance of this indi-
cation, and their remedies for the most part were directed to ob-
tain its fulfilment. In some cases, however, they attempted to heal
the sinus by the introduction of caustic substances into its cavity. It
may not prove uninteresting or inapposite to pass in review some
of their different plans of treatment, and first of Caustics. Hippocrates
formally recommends the application of caustic substances to the in-
ternal surface of a fistulous canal. He applied them by means of a
linen tent, (of sufficient length to pass from one orifice of the fistula
to the other,) which was first rolled in cerate, and then dusted over
with the substance to be used. It was introduced into the tract of
the fistula by means of a probe, to which it was attached by a thread;
this was introduced through the external orifice and brought out
through the anus. A suppository of horn was then inserted into
the rectum. On the sixth day the caustic tent was removed, and a
simple one introduced in its place; the horn suppository was like-
wise removed, and replaced by one of alum. This practice was
founded upon the supposition, that the parietes of every fistulous
canal were necessarily callous, an opinion which it is almost needless
to say, is erroneous. The plan, however, seems to have never ac-
82 Mutter's Instrument for Operating in Fistula in Ano.
quired much reputation, and had nearly fallen into oblivion, when it
was revived by Dionis, in France. Since his time, though frequent-
ly spoken of by surgical writers, it has never been introduced for
obvious reasons into general practice.
Cautery. — Passing a bistoury heated to a white heat along the tract
of the fistula, has also been recommended; this method of course never
obtained much reputation. The rationale of its operation is obvious.
Ligature,—-ThQ treatment of fistula by the ligature is no less
ancient in its origin than that by caustic. To the Coan sage we are
also indebted for this practice, though Celsus, among the ancients,
may be considered as having given the most lucid and useful descrip-
tion of its applicatic n and modus operandi. Almost every writer
since his time has taken especial notice of this practice, some recom-
mending it as the most certain, least painful, and least dangerous of
all methods hitherto made use of; others again condemning it as
tedious, painful, and uncertain. Desault, among the more modern
authorities, directs it to be employed in all cases where the fistula
extends beyond the reach of the finger, and where from the position
of the neighbouring vessels they must unavoidably be wounded in
any operation i erformed with a cutting instrument. His practice
was to pass a leaden wire through the fistula, and then bring it out
at the anus. The ends of the wire were then twisted together, and
the loop gradually tightened every day. By this means, ulceration
and absorption of the barrier between the gut and sinus would in
time be effected, and the two cavities converted into one. The liga-
ture is sometimes made use of at the present day in similar cases,
though for the most part it has been entirely abandoned.
Extirpation. — It is as yet a mooted point to whom the credit of
this operation is due. Pott gives it to Guy de Chauliac; Bertrandi
to iETius, who wrote about the end of the fifteenth century. Celsus
also mentions it. However this may be, the modern surgeon never
thinks of employing it, except perhaps in those cases in which several
fistulse communicate with each other, the parietes of which are ex-
ceedingly callous or scirrhous. In all others it should be rejected, as
it is frequently followed by hsemorrhage, fever, profuse suppuration,
diarrhoea, and contraction of the orifice of the anus from loss of sub-
stance. It consists in the extirpation of a slip or narrow portion of
the barrier between the gut and sinus, by means of two. parallel in-
cisions, and its object is to prevent the too rapid healing of the
wound.
Incision. — The most experienced surgeons of the present era have
Mutter's Instrument for Operating in Fistula in Jino. 8^
for a long time abandoned these different methods, (with the excep-
tion of the ligature occasionally used,) and confine themselves to the
operation, in v/hich the tissues situated between the sinus and cavity
of the rectum, are merely divided or incised. It is to Hippocrates
again^ that we are indebted for this operation, which, although re-
stricted by him to those cases in which there existed no communication
between the fistula and the cavity of the gut, has been applied by mo-
dern surgeons to almost all conditions of the disease. Various instru-
ments and plans of operation have been invented to effect this end
"with the greatest facility to the operator, and with the least pain to
the patient. The French method differs materially from the English
and American. In the French operation, a kind of director, called a
gorget, which is usually made of ebony wood, and intended to be in-
troduced into the rectum, with its concavity turned towards the fis-
tula, is made use of. After this has been properly placed, a steel di-
rector, inflexible, slightly pointed, and without a cul-de-sac, is passed
through the fistula until its point comes in contact with the wooden
gorget. A long, narrov/, sharp-pointed, straight bistour}^, is now in-
troduced along the groove of the steel director, till its point meets
the groove of the ebony gorget, by cutting upon which all the parts
are divided which lie between the internal opening of the fistula and
the anus. The English operation is performed with merely the fore-
finger of the left hand introduced into the rectum, and a knife, which
is passed through the fistula until it arrives at the finger, in ano. The
two, after being properly balanced, are then withdrawn together, di-
viding as they pass along the barrier between the rectum and sinus.
This operation is superior to the French, inasmuch as it is more sim-
ple, and more easily performed. There exists, notwithstanding, a
difficulty to be overcome of no trifling importance in some cases, and
which is occasionally a source of embarrassment to the surgeon, when
the latter operation is performed: it is the introduction of the knife
into the cavity of the rectum when no communication between it and
the sinus exists. The ingenuity of different surgeons has led to the
introduction into practice of several variously-contrived knives, which
have been invented with the design of effecting this indication, and
at the same time guarding the finger of the surgeon from all danger
of being wounded. For the most part, all of those which have come
under our observation are faulty in some respect or other. Before,
however, entering upon an analysis of their merits, it may be as well
to state what indications an instrument intended for operating in fis-
tula in ano, should be capable of fulfilling. In the first place it
should be so constructed that it may be used in all cases of fistula,
84 Mutter's Instrument for Operating in Fistula in Ano,
whether complete or incomplete. 2d. Its blade should be shielded so
as not to cut the tract of the fistula as it is introduced? by which
means the patient is saved a great deal of pain. Sd. Its point should
be so formed, that the finger of the operator, during the division of
the parts, will be in no danger of being wounded by it. 4th. It should
be sufficiently small to admit of easy introduction into fistula of the
usual size. 5th. It should be simple and cheap. Let us see if the in-
struments usually employed fulfil all of these indications.
Prohe-pointed bistoury. — To the common probe-pointed bistoury,
the instrument generally recommended as the most simple and easily
used, it may be objected, in the first place, that in cases where it is
necessary to make an opening into the rectum, it will not answer
from the bluntness of its point; for it will be found almost impossible
to make it penetrate the gut, provided the latter be in a healthy con-
dition, notv/ithstanding the assertion of a celebrated author, " that
the smallest degree of force will thrust the point of the knife through,"
to the contrary. 2d. That it, (as well as any other instrument, the
edge of which is not protected by a sheath,) will give the patient un-
necessary pain, by cutting the whole tract of the fistula, as it is pass-
ed on to the gut. Hence it is seen, that it does not answer the two
most important indications in the operation, though it does the three
others.
Sharp-pointed bistoury. — Should the sharp-pointed bistoury, which
has been recommended whenever it becomes necessary to make an
opening into the gut, be used, the surgeon's finger will most inevita-
bly suffer, and in some cases severely, from the sharp point of the
knife necessarily pressing forcibly upon it. It has been recommended
to shield the finger, either with a common thimble, or a piece of sheet
lead; should either be used, it has a bungling appearance, and does
not always answer the end intended. The same objections then,
which were made to the probe-pointed bistoury, are applicable here,
with the additional one of its always wounding the operator's finger
more or less severely.
Fhysick^s bistoury. — Some years ago Dr. Physick, fully aware of
the imperfections which existed in the instruments usually employed
in fistula in ano, had one constructed, decidedly the most ingenious and
useful that had hitherto been proposed. It consists in a sharp-pointed
bistoury, enclosed in a moveable sheath or guard, so arranged that
when the knife is furnished with its guard, it resembles a probe, and
may be passed down to the bottom of the sinus, without causing any
more pain than would be produced by the introduction of a common
probe. When it has reached the gut, by pressing slightly upon the
Mutter^s Instrument for Operating in Fistula in Ano. 85
guard, which is attached in a peculiar manner, the latter may be re-
moved, whilst the naked blade remains in the sinus. When a hole
is to be made through the gut, the guard must be first disengaged.
This instrument combines, to a certain extent, the advantages of the
blunt and sharp-pointed bistouries, and is infinitely superior to either
when considered alone. There are however some objections to be
made to it; in the first place, the sharpness of its point when the
guard is removed, will almost to a certainty subject the finger of the
surgeon to a severe wound; 2d, as the blade gradually increases in
width towards the handle, where it is quite large, its introduction
will cause pain, unless the fistula is much larger than it usually is;
3d, it is complicated and expensive.
Bistoury of Cruikshank, — The bistoury of Cruikshank may pro-
bably be considered as the best instrument met with at the present
day in practice, though it is liable to the objection of cutting the fis-
tula as it passes through its tract, and also of being wider than neces-
sary; it is moreover expensive. It is constructed with a moveable
stilet, which passes along the side of the blade, and may be pushed
forward or retracted at pleasure; its point is intended to pierce the
gut, and then to be withdrawn, that the surgeon's finger may rest on
the blunt extremity of the knife.
This completes the list of instruments usually made use of in prac-
tice; many others have been invented, none of which, I believe,
have acquired any reputation, or at best only an ephemeral one. No
instrument, however, it is seen, has ever been proposed, which an-
swers all the indications stated above. Let us see if the one about
to be described comes up to our definition of " a fit instrument for
fistula in ano." To Frere Come, or rather to Bienaise, are we in-
debted for the principle of the '* bistoire cache." Hitherto it has
been confined chiefly, if not exclusively, to instruments intended for
the operation of lithotomy; at all events, I believe it has never been
applied to an instrument for operating in fistula in ano. Struck with
the advantages that an instrument contrived upon this plan, modi-
fied however as regards the arrangement of the blade, would possess
over any other as j^i invented, with the assistance of Mr. Rorer,
instrument-maker, I fashioned the one represented in the annexed
cut. Like the lithotome cache, it consists in a handle and blade
part, the latter four inches in length, and one and a half lines in
diameter, slightly curved, and excavated so to form a sheath for a
knife of its own length. Instead of terminating in a closed beak, or
cul-de-sac, like the lithotome, it is opened at its extremity, to allow
the knife to be pushed forward like a stilet. The handle of the
No. XXVII. —May, 1834. 8
86 Mutter's Instrument for Operating in Fistula in Jlno.
No. 1
No. 2.
hnife being so arranged, that it operates as a lever, the knife, as in
the lithotorae, may be made to start out from its sheath, by depressing
its handle. By means of a mortice cut in the
shank of the knife, through which the rivet
attaching the knife to its sheath passes, the
former may be shoved forward, or retracted
at pleasure, like a stilet in its canula, by
merely acting upon its handle. The point of
the knife should be sharp, and its width
throughout sufficiently narrow to admit of its
being completely concealed by its sheath, to
avoid cutting the fistula during the introduc-
tion of the instrument. To prevent the knife
from slipping forward, when the lever is de-
pressed, which it will do, after the instru-
ment has been used several times, a small
steel pin proceeds from the handle of the
knife^ and fits into a small, round hole in the
handle of the sheath. The object of the knife
being made moveable in its sheath is, that in
cases where there exists no opening in the
gut, one may be made by merely pushing upon
its handle. The principle upon which the in-
strument operates, is obvious at once, and its
great utility in cases of blind external fistula
must be equally apparent. It is used in the
following manner: — -The patient having been
properly prepared for the operation by pre-
vious treatment, is to be placed as in the
usual operation for fistula in ano — upon his
No.i. Represents the instvu-^ands and kuccs, with the light falling upon
"^t^-^Zl^l^i^l^^SM buttocks. The surgeon then passes the
the^'n^e^rsiSh;^^^^^^^^ forc-fiugcr of his left hand, well oiled, into
when the lever is depressed, a. the rcctum of the patient. The instrument
The lever in the position it occu- J^ • -vt
also well oiled, and closed as in JSo. 1, (see
pies when not depressed.
No. 2. Represents the mecha- x • , , 1,1 1,1 , 1
nism of the instrument. The cut,) IS then passcd through the external ori-
lever depressed, c. The knife „ ' iiji j > c i.\ n ^ ^ ±-\ 'j.
thrown out of its sheath by the ticc, and aloug the tract 01 the nstula, until it
depression of the lever; its point • ..1 . r. , -ij • a. \
projecting beyond the beali, as amVCS at the Orifice, (prOVlUed OUC CXlStS,}
when it is used as a stilet. d. A • ,\ j. ' 1 \^^ 1. 1 -x • zi
part ofthe mortice in the shank of in the gut; its blunt cxtrcmity IS then receiv-
^ush^d^'^rw'aitrSi^ii^^^^ upon the fiugcr in ano, and the two pro-
pieasm-e. pcrly balanced; the lever is then depressed^
the knife starts out, and the finger and instrument being drawn out
together, all the parts intermediate to the inner orifice of the fistula
Horner's Case of Hepatic Abscess. SI
and the anus, are divided, and the two cavities converted into one.
When however no opening exists in the gut, the operation ditFers
somewhat from the one just described. The finger and instrument
are introduced precisely as in the other case, but instead of their
coming into immediate contact at their extremities, they will be se-
parated from each other by the wall of the rectum. An opening of
course becomes necessary, and may be made in the following man-
ner:— Having determined by the touch the spot through which it is
to be made, the surgeon ?lips his finger from the point of the beak, a
little to one side of it, whilst with the thumb of the hand holding the
instrument, he thrusts forward the knife, by acting upon its handle;
its point is thus made to penetrate the coats of the gut, and an orifice
large enough to permit the instrument to pass into the cavity of the
rectum is establislied. The stilet is then to be retracted, the point of
the finger and the blunt beak of the instrument balanced upon each
other; the lever depressed, and the operation finished as in the first
instance. The wound is to be dressed as in the ordinary operation
for fistula in ano, and the after treatment is precisely the same. It
will be seen at once, that this instrument fulfils to the letter the
difterent indications in the operation for anal fistulse. It may be used
in all cases! its introduction gives the patient no more pain than
would be produced by the passing of a common probe! The finger
of the operator is perfectly secure from all injury! it is so small, that
it may be introduced into almost any fistula without difficulty, and
it is simple and cheap. It possesses moreover the advantage of being
applicable to many other operations. It can be used in all cases of
fistulas, in whatever part of the body they may occur, in phymosis, in
fissure of the anus, in abscess of the fauces, in hernia, &c.
Art. VI. ^ case of Hepatic Abscess, in which Tapping was Per-
formed before Adhesion of the Liver to the Side had occurred; and
the Appearances after Death. By W. E. Horner, M. D. Profes-
sor of Anatomy in the University of Pennsylvania.
llOBERT MILES, tax-collector, a respectable and valuable citizen,
aged fifty-four, a short, stoutly-built man, whose habit of body
had been impaired by previous attacks of sickness occurring at distant
intervals, and by haemorrhoids; was seized about the 1st of December,
1832, with symptoms of dysentery, which disappeared under treat-
88 Horner's Case of Hepatic Mscess.
ment bj Dr. Chapman and myself in sixteen days. They seemed to
be connected with an elastic tumour of an inch in diameter in the linea
alba of the epigastric region,* this tumour was taken for a hernia of
the stomach or colon, and having diminished much as he convalesced,
got entirely well in a io^w weeks afterwards.
On the 25th day of May, 1833, he suffered from an attack of colic
followed by diarrhoea, and the bowels continued loose and irritable
for some time.
July 18th, being in the country for the recovery of his health, he
was seized with severe pain in the epigastric and right hypochondriac
regions, attended with fever, and came under the professional treatment
of Dr. Vandyke, to whom I am indebted for the following statement: —
" Dear Sir,
" On the 19th of the month of July, 1833, I was requested to visit Mr. Miles
at the residence of his son-in-law, Capt. Robinson. The general appearance of
the patient. evinced debility and emaciation of body. The complexion pale and
sallow, pulse frequent and feeble, coldness of the hands and feet, indicating a
disturbed balance of circulation. He complained of an obtuse pain in the right
hypochondriac region, sense of fulness after eating, but could lie on either side
without any sensation of weight or dragging, from which I inferred that no
morbid adhesions then existed; had no cough; appetite diminished, and diges-
tion imperfectly performed; slight and irregular chills were felt through the
day, and a febrile paroxysm occurred every evening, terminating in profuse
perspiration. Tongue slightly furred; sleep disturbed; biliary secretion vitiated;
stools frequent, exhibiting a frothy, yeast-like consistence, of varying and un-
natural colour. An examination of the body discovered an enlarged and indu-
rated state of the liver. The nervous organism was not materially affected, and
the mental energies and spirits were unimpaired.
" A careful consideration of these symptoms led me to the conclusion, that
the patient at that time laboured under an hepatic obstruction and chronic en-
largement of the liver. The indications of treatment deduced from these morbid
phenomena, were the reduction of the periodical febrile excitement, and the
removal if possible of the hepatic obstruction and induration. These were at-
tempted by external frictions and irritative applications over the region of the
liver, and by mercurial remedies, &.c. He was ordered three grains of calomel
at bed-time, with a table-spoonful of the expressed juice of taraxacum on the
following morning, to be taken every second night, and to use daily frictions
of a wash, impregnated with resinous fumes upon the right hypochondrium,
with mustard applications. During the febrile paroxysm he was directed to
take forty drops of sp. nit. dulc. every two hours; and the occasional use of
mustard sinapisms to the extremities. Diet abstemious, light, and of easy di-
gestion. The pursuance of this treatment, slightly varied according to circum-
stances to the 13th of July, was attended with some advantage. The febrile
paroxysm and night sweats ceased; the appetite was somewhat improved; the
strength increased; the evacuations were more natural in appearance, but still
Horner^s Case of Hepatic Abscess. 89
too frequent; and the enlargement of the liver remained unchanged. A cre-
taceous julep was now ordered in occasional doses as the state of the bowels re-
quired, and a seton recommended.
" It was at this date proposed to Mr. Miles by some of his friends to try a trip
to the sea-shore, as his strength was improved. To this proposal, upon being
consulted I consented, desiring him to continue the remedies during his visit,
and to return immediately should it not agree with him.
"I did not see him again until about the 20th of August, when I received a
visit from him at my house for the purpose of obtaining further advice. He
seemed evidently benefited in appearance and strength. A continuance of the
remedies was advised; substituting for the calomel, grs. iij. of mass, hydrarg.
and the extr. taraxac. for the fresh juice. The seton was again recommended.
" With sentiments of the highest respect,
*' I am, your friend,
" F. A. VANDYKE."
** Hawthorn Cottage, Oct. Uih, 1833."
Jlitgicst 9.5th. — Mr. Miles had a renewal of his attack of hepatitis;
a considerable tumefaction of the right side was apparent, attended
with extreme pain. The ordinary depletory remedies were resorted
to by Dr. Thomas Harris, who, in consequence of my being
from town, was kind enough to take charge of the patient. He
was leeched on the side freely: a blister plaster was then applied,
and the blistered surface kept open; it being dressed occasionally
with morphia to diminish the intensity of the pain which shot down
from the liver to the right iliac region. The administration of blue
mass with morphia was also instituted; the mass being given to the
amount of two grains daily.
On the 2d of September I resumed the charge of the patient, and
continued with but little interruption the treatment which had been
instituted by Dr. Harris. The descent of the liver below the right
margin of the thorax, amounted at that time to three or four inches,
and it formed a very conspicuous indurated swelling. About the
tv/entieth day of the month, fluctuation was perceived, and became
•each day afterwards more distinct. Occasionally excruciating pa-
roxysms of pain came on, which were generally relieved by an opiate.
The patient in the meantime evidently declined in health, and be-
came subject to exhausting perspirations. Under these circumstances
v/e looked anxiously for the spontaneous evacuation of the abscess
through some of the common routes for such matter, but being dis-
appointed in this, the expediency of operating through the side was
suggested, as it was clear that death must come in a short time with-
-out relief. The great objection to the operation was however igno-
rance of the fact, whether an adhesion had formed between the liver
and the anterior side of the abdomen, and if this were not the case,
8*
90 Horner's Case of Hepatic Mscess.
the unavoidable risk of opening the cavity of the peritoneum, and the
probability of some of the matter of the abscess running into it and
producing inflammation.
The case being in this unpromising condition in every view of it
. which could be taken 5 a choice of evils only was left, and with the
^ consent of the family, and the advice and assistance of Dr. Harris,
;^the operation was undertaken October 1st. An incision was first of
all made horizontally on a line with the anterior end of the eighth
rib on the right side, a little in front of its cartilage, and through the
side of the abdomen, which brought the liver into view; the latter
was seen to rise and fall with the diaphragm in respiration; moreover,
a knife handle was introduced between the surface of the liver and
of the contiguous part of the abdomen; these two facts made clear the
thing apprehended, to wit, want of adhesion. In this dilemma I de-
termined to stitch the liver to^he side, which was accomplished with
a large crooked needle, armed with a ligature of kid skin, and of
bulk sufficient to fill up the hole made by the needle. One stitch was
made in this way parallel with the upper margin of the incision at the
distance of four lines from it, and another in the same manner below.
The liver being thus fixed closely to the side, a trochar and canula
were plunged into the abscess, and five gills of purulent matter were
immediately discharged to the great relief of the patient; the matter
continued to flow during the night, so that three or four more gills
were discharged. The operation being ended, a bandage was put
around the abdomen so as to keep its viscera as still as possible. The
canula was left in for fifty-four hours, and then a piece of a flexible
catheter was substituted. The abscess discharging all this time small
quantities of pus and serum mixed.
On the second day the bowels became tympanitic, and there was
hiccup, with cholicky pains. On the third day there was a manifest
declension of strength, and it became evident that the previous ex-
haustion of the patient must lender the operation nugatory. The
symptoms of debility increased, and the patient died on the 5th inst.
No sign of peritonitis followed this operation.
In twenty-two hours after death an examination was made. A re-
cent adhesion between the liver and side had occurred immediately
around the puncture of the trochar, and which along with the stitches
had prevented any pus from getting into the cavity of the peritoneum.
The latter membrane was entirely sound, and had no appearance of
being irritated by the operation. The cavity of the abscess was col-
lapsed very much, and contained shreds of coagulating lymph mixed
with p«s, amounting in all to about one gill; its parietes were. lined
Ticknor's Case in which Sand was voided by the Mouth, Sfc. 9 1
by a membrane. The right lobe of the liver being the seat of it, the
anterior half was gone, but it appeared to be rather by pressure and
absorption than by dissolution, as no remains of the liver were seen
in the discharges. There was no preternatural adhesion of the liver
to the parietes of the abdomen, excepting what was made by the ope-
ration. The left half of the stomach was destitute of mucous coat,
it having been dissolved completely, so as to exhibit the cellular coat
naked. Six inches of the beginning of the colon were studded with
ulcers having red, injected, and elevated edges. The small intestines
were sound.
Though life was not saved by this operation, evidently owing to
the exhaustion of the patient at the time of its performance; I yet con-
sider it as illustrating the fact, that hepatic abscess may be managed
by opening it, even when adhesion to the side has not occurred;
provided the liver be secured in the way described, or by an equiva-
lent process; and after a deliberate review of the case, I only regret
that I did not resort to this treatment when the abscess first fluc-
tuated.
Art. VII. Case in which Sand was voided hy the Mouth, Rectum,
Urethra, Nose, Ear, Side, and Umbilicus, and attended by various
other Anomalous Symptoms. By C. Ticknor, M. D. of New
York.
Miss LUC Y parsons, of Egremont, Berkshire county, Massa-
chusetts, when about eleven years of age received an injury, by the
fall of a barrel across her loins, which was followed by exquisite painy
and an almost total loss of the power of locomotion. The pain after a
time subsided, and the ability to walk gradually returned, though
partial paralysis of the lower extremities, accompanied with severe
pain, would almost invariably recur after much exercise. This state
continued till about seven years after the receipt of the injury, when
some portion of the surface was attacked with an erysipelatous in-
flammation, which, by metastasis, fixed itself upon the abdominal
viscera. The patient now suffered excruciating pains, particularly of
the right lumbar region, together with all the various symptoms of
diseased stomach and bowels, was unable to walk, and mostly con-
fined to her bed, till I saw her in the autumn of 1831, more than
twenty years after the attack of erysipelas.
My brother first saw the patient in consultation with her attend-
92 Tieknor's Case in wTiich Sand was voided hy the Mouth,Sfc,
ing physician: he found her labouring under a profuse diarrhoea, which
threatened a speedy termination to all her sufferings^ food would pass
in ten minutes^ to all appearances precisely as it was taken into the
stomach, without smell or change of colour. At this time a few grains
of calomel put a stop to the diarrhoea, and the patient remained one
hundred and nine days without any fecal evacuation joer rectum. The
most active cathartics had no other effect than to cause pain and irri-
tation of the bowels, and a vomiting of their contents. An injection
thrown into the rectum would be vomited in a few minutes, having
the same appearance as when administered, and free from any ad-
mixture of feces. During this period of one hundred and nine days
the patient experienced a regular vomiting each day of the food, pro-
perly digested, which she had taken the preceding twenty-four hours.
About this time there was something of a peculiar appearance in the
matter vomited, which, on washing, proved to be sand; and on exa-
mination it was found that sand was also discharged with the urine.
The bowels resumed their office, and it now became the turn of the
bladder to have its contents expelled by vomiting; the patient expe-
rienced a strong desire, without the ability, to pass the urine by the
urethra, and on trying to introduce a catheter, the passage was found
occupied by a hard substance, which rendered the operation impossi-
ble. The urine was now vomited for several days, though it occa-
sionally passed joer rectum^ mingled with sand, till a quantity of sand
stones, or lumps of concrete sand, were discharged from the urethra,
when the urine again flowed through its proper channel.
The pain continued unceasing in the right side; a small abscess
formed, which, being left to itself, opened and discharged, with a
small quantity of pus, several lumps of sand; and in the efforts at vo-
miting, feces escaped through the same opening.
June Sth, 18S2. — No fecal evacuation from stomach or bowels in
forty days; has taken a great deal of cathartic medicine; vomited her
.urine; vomited injections in fifteen minutes after being adm.inistered,
without the least appearance of any feces; appetite pretty good,
though she takes but little food; tongue of an inky blackness, except
the edges, which are red; complaining of excessive pain in right
side and stomach; says she can feel lumps of sand moving inside;
«and passes through the external opening in the side, mixed with
blood, and sometimes feces; has had spasms of the muscles about the
throat and jaws.
15th. Pain very great; jaws spasmodically closed; mouth filled
with lumps of sand, several pieces passed out at the nose; saw her
eat some bread and milk, and in a very few minutes it passed oat at
Ticknor^s Case in which Sand was voided by the Mouth,Sfc, 93
the opening in the side; tried to introduce a probe into tlie orifice
but could not succeed; could feel the sand in the side.
lAth. Received a note from the patient's brother, saying that his
sister this morning passed by stool, at one sittings forty-four lumps
of sand,
9.5th, The lumps of sand discharged on the 14th, vary from the
size of the fore-finger to the first joint to that of a small pea; no fecal
evacuation from stomach or bowels since last date; for the first time
during her illness, she has since last visit vomited purulent matter,
and voided it by stool.
July 19th. — Received the following account from the patient's sister
of her state since last visit. On the 6th inst. her jaws became spas-
modically closed; bowels for three succeeding days regular, since
then no discharge per rectum; regular vomiting once a day of fecal
matter, which is quite fluid, and escapes between the teeth; 8th,
right ear began to bleed; 12th, discharged a watery fluid resembling
urine with sand.
30th. An abscess opened just above the symphysis pubis, and dis-
charged a small quantity of pus, afterwards urine mixed with sand,
which continued for a week. Present symptoms — appetite pretty
good; takes liquids, which she sucks between her teeth; jaws being
yet firmly closed; vomits feces every day, the fluid part escapes be-
tween the teeth, and the more solid part is again swallowed; has
lumps of sand in her mouth, which have been there eleven days; a
dose of tartar emetic caused a little relaxation, and the mouth was
emptied; at this visit I saw her vomit her urine, one gill, perfectly
transparent, as if just passed by the urethra; saw a tea-spoonful of
fluid discharged from the ear with sand, and a lump of sand from the
nose; sleeps little; suffers exquisite pain; another abscess seems to be
forming in the right side; more emaciated than I have seen her at any
period of her illness.
August 1st. — Jaws yet closed; vomits, or passes by stool every few
minutes, a whey-like fluid; retains veiy little food; since last visit
voided by stool at once a table-spoonful of sand with a tea-cupful of
pus, and soon afterwards there was discharged in the same way a
membrane-like substance, of the size of a crown-piece, containing a
number of fine, delicate hairs; there is voided now sand and urine by
the mouth, rectum, urethra, nose, ear, side, and umbilicus! Treat-
ment— Nit. argent, grs. x., op. xv., ft. pil. xx., one every fourth
hour; foment abdomen, side, and throat, with decoction of cicuta.
ISth. Symptoms of same character, though much mitigated in vio-
lence. Continue the same treatment.
94 Ticknor's Case in which Sand was voided by the Mouth,^^c.
September 1st. — No diarrhoea^ some vomiting; pain of left side; no
discharge of sand since last date; deaf with right ear; vomits urine
occasionally; for two weeks has been troubled with spasms resem-
bling epilepsy, has twenty or more in a day, is warned of their ap-
proach by pain in the epigastric region; left leg strongly flexed upon
the thigh, heel drawn up and lying upon the glutei muscles, and has
been so for twelve days; appetite good, but most of the food is reject-
ed soon after eating. Take the following pill every fourth hour — Ext.
hyosciami, grs. iij., castor, grs. ij., nit. argenti, gr. i. ; laud, and ext.
cicuta between the pills in quantities sufficient to procure sleep or
quiet; foment spine, side, and epigastrium, with decoct, cicuta.
loth. — No spasms since last date till to-day; omitted the pills yes-
terday, and to-day the spasms returned; no natural evacuation from
bowels or bladder since 20th July; contents of both are vomited; ap-
petite tolerable; has ridden out several times since last visit; left leg
continues flexedo Treatment, the €ame.
October, 1833. — Have not seen the patient for more than a yeari
her sister gives the following account of her condition during that
interval. Her bowels soon became quite regular, and so continued
for some time, then relapsed into their former obstinately costive
state, when their contents have been vomited; appetite has been ge-
nerally good; left leg during the whole time has continued flexed,
and attempts to extend it have invariably caused frightful >spasms;
has ridden out frequently, done a good deal of needle work, and may
be said to enjoy comparatively good health. I ought to add, that dur-
ing the whole illness of this patient her catamenial evacuations have
been generally regular, though at times rather profuse.
A lump of sand discharged from the bowels, which Dr. Torrey
and Dr. C. A. Lee, of this city, had the kindness to analyze for me,
proved to consist of silex and lime, and a few short hairs; the former
making much the greater proportion. Professor Averill, of Schenec-
tady, did me the same favour, with the same result.
Most of the facts related in the above case, besides being witness-
ed by my brother. Dr. L. Ticknor, of Salisbury, Conn, and myself,
can be vouched for by the following gentlemen. Dr. Bolton, of
Egremont, Dr. Kellogy, of Sheffield, Dr. Wheeler, of Great Bar-
rington, Professor Averill, of Union College, Drs. Cleaveland and
Flallenbeck, and Mr. Oliver Whittlesey, of this city.
The interesting features of this case will readily suggest them-
selves to the mind of every reader. It furnishes an extraordinary
example of the amount of disease the system can sustain when na-
ture is playing her wildest freaks.
Jackson's Case of Purpura Hsemorrhagica. 95
In regard to the imposition which the patient practised, or at least
inight have practised, I may state that she has sustained a character for
genuine piety, and to have lived with her two maiden sisters who have
had the sole care of her for more than twenty years; they had a small
estate, which, with frugality, would support them all, and there ca
be no reason why she or her sisters should wish to deceive. I have
hesitated about publishing the case, but I believe it a duty I owe to
my profession not to withhold the facts, however they may be ac-
counted for, or however little they may be believed. I have thought
best to give the facts and the facts only — the patient is still living
about fifteen miles from where my brother is practising, and he may
yet detect her in her imposition if she is not put upon the look out
by publishing speculations prematurely. Can these phenomena bs
accounted for without calling the aid of imposition.^
No. 369, Hudson street, New York, Dec, 31s/, 1833.
Art. VIII. Case of Purpura Hsemorrhagica. By Samuel Jackso«',
M. D. Assistant to the Professor of the Institutes and Practice of
Medicine in the University of Pennsylvania.
1 URPURA is a disease that occasionally presents itself to the ob-
servation of practitioners, though not of frequent occurrence. Its
pathology is involved in great obscurity. No hypothesis yet sug-
gested can be adopted, as cases are to be met with that contradict in
their facts the presumed solutions of the pathological problem.
The disease belongs apparently to the haemorrhages, but the proxi-
mate cause of the haemorrhage has as yet resisted all scrutiny that is
satisfactory. It assumes two forms — the simple, when a drop of
blood exudes beneath the cuticle, the serous or fibrous membranes, or
in the parenchyma of the organs. These are intermingled with vibices
and ecchymoses. In the second form, along with the preceding cir-
cumstances, there is effusion of blood from some portions of the
mucous membranes, and occasionally from the skin. The first affec-
tion is generally, if not always curable; the last is often fatal. Both
occur in individuals of dissimilar constitutions, temperaments, habits
and conditions of life.
Phoebe M'Gonagle, aged forty-seven, had been an inmate of the
Alms-house for the last two years, most of which time she had
96 Jackson's Case of Purpura Haemorrhagica,
passed in women's medical ward, and in bed^ her complaint being
chronic rheumatism, for which only a palliative treatment had been
pursued. Her gums bad been in a diseased state for a year, but
never discharged blood. To the best of her knowledge, she was
never salivated. During most of her stay in the house, she has been
on good diet, with a portion of wine daily. About the third week in
December, 1833, she commenced to discharge blood from the mouth,
and passed in twenty-four hours nearly, if not entirely, a half a pint.
She complained of pain in the chest and nausea, cough, and appa-
rently expectoration of blood. Ecchymosis followed the application
of cups to the chest, and the following day purple spots appeared on
the arms. The pulse was feeble and frequent. A gargle of sulph.
zinci, and a strong infusion of pulv. gallse were directed, and to pro-
cure sleep, which the patient could not before obtain, opium was
given at bed-time. The patient was greatly depressed in spirits,
and was getting worse. At this time I saw the patient, and directed,
R. Tartrat. ferri, Jj*? aqua, 5iv. Haifa table-spoonful four times a
day. Also, R. Nitro-muriatic acid, jj., aqua, §iv., honey, ^i. Tea-
spoonful every hour. The stomach could not retain the remedies,
and they were discontinued. I then substituted, as a gargle, Dipple's
animal oil, gtt. ij., aqua, §iv. During the last twelve hours the pa-
tient has discharged nearly a pint of blood from the mouth, and a
small quantity from the vagina. The blood coagulates about the
gums. A nutritious diet is allowed her, but she has little relish for
any thing.
January 9>d, 1834. — Spots of purpura on every portion of the body;
large patches of effused blood in the mucous membrane of the mouth;
the body was sponged frequently with the following: — R. Chlor. sodse,
5j., aqua, §vj.
3c?. Not much amendment. Patient complains of intense pain in
the epigastrium. Discharges of blood from the bowels; pulse very
feeble. A blister was applied for one hour to the epigastrium, and
ol. terebinth, gtt. iij. administered every hour.
4th. She is very feeble. Skin sallow, and covered with purpura
and ecchymosed spots. Her stomach revolts against the turpentine,
and indeed every thing excepting wine whe3^ Directed R. Cal. grs.
ij., pulv. rhei, grs. vj. every four hours, and an injection of salts and
senna. The haemorrhage from the bowels the succeeding day was
nearly suspended; on the 5th it returned. The best of diet, as es-
sence of beef, oysters, and eggs was allowed her; brandy, with tinct.
rhatany were exhibited to sustain her forces, and arrest the hsemor-
Jackson's Case of Purpura Hsemorrhagica, 97
rhage. But every thing proved fruitless, and at 3 P. M. of January
7th, she expired, the blood continuing to the last to issue from the
gums, and to be discharged from the bowels and vagina.
Post mortem appearances, January, 9th, 1834. — Emaciation not
very greats skin generally sallow; purple and scarlet spots upon the
skin of the eyelids, about the nostrils, around the mouth, upon the
upper and lower extremities and body; these spots varied in size
from a pin's point to that of a sixpence. In some places, especially
upon the anterior surface of the thighs, there were ecchymosed spaces
and streaks of discoloration, two or three inches in extent. Several
of the small spots were covered with dried coagulated blood, that
had oozed from the pores. Thorax; adhesions strong between the
pleura pulmonalis and costalis; left lung exhibited the vesicular em-
physema, otherwise this lung was healthy. The apex of the right
lung filled with immature tubercles; one inch from this there was a
mass, of the size of a hazel-nut, of tubercles in the same condition;
also at the root of this lung there were half a dozen small tuber-
cles, which were blackish externally, white and hardened internally;
in a portion of the upper lobe was also vesicular emphysema, while
the lower lobe was free from it. Heart; some few purpura were
upon the inner surface of the pericardium, also upon the fat upon the
posterior portion of the heart. The muscular part of the right auri-
cle was infiltrated with blood of a scarlet hue; the remaining portions
of the heart natural; lining membrane natural aspect. A purpuric
spot of a bright red colour was on the inside of the epiglottis, another
extended from one arytenoid cartilage to the other; three inches be-
low this there was a patch of a deep bluish colour; the mucous mem-
brane of the oesophagus was upwards of four times its natural thick-
ness, and its density throughout its extent augmented; in colour it
was of a deep port-wine red, approaching to black; it was also co-
vered with an adventitious membrane, which was in a state of inci-
pient putrefaction. The surrounding cellular membrane was injected
with blood, which at first was black, but upon exposure, it changed
into a florid colour, proving the blood to be susceptible of atmosphe-
ric influence. A superabundance of fat was found in the greater
omentum. Stomach; its villous coat was covered with a gelatinous,
greenish mucus; beneath this it was injected with blood of a bright
hue; consistency natural. The duodenum and upper portion of the
bowels were nearly filled with thick yellow mucus; the lower part of
the ileum contained it of a dark brownish-red. A thick, tenacious,
tarry-like substance was found in the lower part of the colon and in
the rectum. The coecum after washing showed its inner surface
No. XXVII— May, 1834. 9
98 Jackson's Case of Purpura Haemorrhagica,
much discoloured; four inches from the caput coli there were many
dark enlarged mucous glands, varying from one-eighth to one-half an
inch in length, and covered with coagulable lymph; this patch of
tumours was four inches in extent; then succeeded a large ragged
ulcer, with an indurated base; below this the colon was discoloured
with livid spots for five inches. The tumours again commenced, and
continued for eighteen inches. Lower down, the mucous membrane
was merely discoloured with a darkish hue; several ulcerations were
found about the ileo-colic valves. Kidneys; the right one externally
resembled the spleen in appearance; its structure was injected. Left
kidney; its pelvis and calices filled with dark soft coagula; the ureter'
enlarged, and the upper portion highly injected. Pancreas very hard,
and contained caseous matter. Uterus; its membrane very white;
the upper cavity contained albuminous fluid; several purpura around
the neck and upon the vulva. Cranium; several purpura beneath the
scalp. Brain; considerable effusion of blood beneath the dura mater;
blood partly coagulated; congestion of florid blood along the course
of the longitudinal sinus. Structure of the brain softened.
Observations. — For the above account of the case and autopsy
I am indebted to Dr. Porter, resident physician to the Alms-
house. The patient of the above case was of broken down con-
stitution, having long sufiered under disease, and it might be pre-
sumed that this was the predisposing cause of the purpura. It how-
ever occurs in individuals in the enjoyment of robust and vigorous
constitutions, and the affection cannot therefore be regarded, in a po-
sitive manner, as proceeding from that cause.
So far as the general properties of the blood are indicative of a
sound condition of that fluid, it manifested a healthy state. It coagu-
lated in the mouth and on the gums, as rapidly as it was effused. It
was found coagulated in the body. Exposed to the air it rapidly as-
sumed the scarlet hue, showing the preservation of its natural rela-
tions to the air. It is not then probable that the blood was materially
changed in its condition, and the cause of purpura cannot be looked
for in a diseased state of this fluid.
In examining attentively the spots of purpura and the ecchymosis
by dividing through the tissues, I could not discover any appearance
of a coagulum, indicating an effusion or extravasation of the blood. It
appeared much more to resemble a circumscribed collection of blood
in the minute capillaries or areolar texture. Can the disease be con-
nected with the capillary circulation?
In this patient the general circulation was exceedingly feeble — the
pulse scarcely perceptible. An inordinate force of the action of the
heart was not in this case the cause of the haemorrhage and purpuric
Gerhard on Cerebral t^ffections of Children. 99
maculae, though such a conjecture has been made in explanation of
their production.
The oesophagus and alimentary canal exhibited the evidences of
prolonged disease. The oesophagus was more especially the subject
of pathological derangement. Its mucous membrane was hypertro-
phied, indurated, and nearly black. The cellular tissue below it in
the same state. Its surface was lined with an ancient exudation of
lymph, which had fallen into a state of putrid, semifluid sanies. This
condition of the oesophagus will account for the difficulty the patient
experienced in taking aliment and the remedies prescribed. It was
impossible to sustain her forces.
This case, though it exhibits chronic structural disorder sufficient
to account for the general loss of health, the exhaustion and feeble-
ness of the patient, prior to the attack of purpura, throws no light on
the specific pathology of that disease.
Art. IX. Cerebral Affections of Children. By W. W. Gerhard,
M. D. (Second part.)
In the first part of this essay I published the details of ten cases of
the cerebral affections of children; it was my original intention to
have enlarged the series by annexing such cases as I had subsequently
collected at the Children's Hospital of Paris. It would I find be in-
compatible with the limits of the journal to give so great an extension
to a single article; I shall therefore confine myself to the cases al-
ready detailed, as the proofs of the deductions at which I may arrive;
these observations, in common with others which I have not publish-
ed, will form the materials of the second part of the essay.
The anatomical lesions constitute the distinctive characters of the
three classes into which I divided the cerebral affections of children.
The first class included such cases as offered an evident lesion of the
brain, or its membranes, without the presence of tuberculous or other
accidental tissue; this class is by no means so distinct as I had at
first thought; the autopsies prove that the appearances in all the ten
cases either possessed the evident characters of tuberculous matter,
or approached them so nearly as to render it impossible to indicate
the precise line of demarcation. The cases were selected from such
as were least clearly dependent upon the deposit of tuberculous mat-
ter in the brain or its meninges, and therefore lead us to suspect a
100 Gerhard 0^2 Cerebral t^ffections of Children.
fact which will be presently more fully developed; that is, the close
connexion, if not identity, of one form of cerebral disease with the
tuberculous affections. The classification which was legitimately as-
sumed for the convenience of study, should therefore be modified,
and the first division will include all evident alterations of the brain
or its membranes, whether these alterations be connected with the
presence of tubercles or tuberculous granulations, or without evidence
of the existence of any accidental tissue. The second class includes
cases in which the presence of one of the accidental tissues, other
than the tuberculous, was detected; it includes but two cases, one
in which a cerebriform or encephaloid tumour was found immediately
beneath the junction of the optic nerves, and another which presented
a fungoid tumour in the posterior part of one of the lateral ventricles.*
The third class will not be modified, but will still include such cases
as presented no evidence of alteration of the brain or the meninges.
The most important fact to which this series of observations has
led, is the proof of the connexion of the cases included in the first
class with the tuberculous affections. It was long since remarked, that
many children who had died of a cerebral disease, were of a scrofulous
temperament, but it was impossible either to confirm this remark, or
to point out the cases to which it should be limited, without the aid of
pathological anatomy. The obscurity which exists in the application of
the terms acute hydrocephalus, or according to M. Guersent, menin-
gitis, has led to the extreme diversity of opinion amongst physicians as
to the mortality and possible cure of this disease; with the greater per-
fection of diagnosis a more exact appreciation of therapeutic means
becomes practicable, and the singular discrepancy of opinion which
prevails in the treatment of hydrocephalus may be readily explained.
The tables which follow, contain in one column the name, age,
and sex of the children; under the same head the organs which con-
tain either tuberclest or grayish semi-transparent granulations are
noticed. The lesions of the pia mater are mentioned in the second
column, which characterizes the affection. Another column contains
the quantity of liquid found in the ventricles, and the fourth, the
state of the cerebral substance. The tabular form will greatly faci-
litate the deductions.
* This specimen I presented to the Society Anatomiqut of Paris; a notice of
it will be found in the first or second bulletin for 1834. (Archives Generales de
Medecine.)
\ The term tubercle is used in the generally received signification, that is,
a rounded or amorphous substance, yellowish, hard, and with a dull, uniform sur-
face if cut.
Gerhard on Cerebral Jiffections of Children. 101
1. Rebours, male,
set. 6.
Tubercles in bron-
chial glands and spleen.
2. Deucar, male, set.
11.
Scrofulous abscesses
on limbs; bronchial
glands cretaceous.
Pia Mater.
Infiltration of yellowish, con
Crete, tough substance into tlie
pia mater around the optic
nerves.
3. , male, set. 15.
Tubercles in pleurae
and bronchial glands;
gray semi-transparent
granulations through
both lungs.
4. Erlemont^ female,
set. 5.
Tubercles in left lung
and bronchial gland;
Caries of foot.
5. Jeannette, female,
t. 2.
Bronchial glands tu-
berculous.
6. Bellavoine, male,
set. 6.
Tubercles and granu-
lations in botli lungs,
liver, and mesenteric
glands. Bronchial
glands?
male.
7. Trehlue.
set. 6.
Opaque tubercles in
each lung; cavity in the
right. Bronchial glands
tuberculous. Peritone-
um, liver, and spleen tu-
berculous.
. Margotin. female,
set. 8.
Tubercles and cavity
in right lung; granula-
tions in left; bronchial
glands tuberculous; ul
cerations in small intes
9. Landras^ female.
t. 6.
Broncliial glands con-
tain cretaceous matter.
Tubercle in cerebellum..
10. Foi-tin, male, set. 4.
Tuberculous granula-
lations in right pleura.
11. Maycn, male, set.
Gangrenous cavities in
the right lung. No tu-
bercles formed.
Yellowish substance in the fiS'
sures of Sylvius and around the
optic nerves. Slight yellow iiv
filtration on the convex surface,
Yellow opaque matter around
the optic nerves, and in the fissure
of Sylvius.
Slight thickening around the
optic nei^vesjand hard semi-trans-
parent granulations in each
fissure of Sylvius.
Gray granulations on convex
surface of the ai*achnoid. Con-
crete whitish substance in both
fissures of Sylvius and around
optic nerves, containing some
hai'd whitish granulations.
Opacity in fissures of Sylvius,
Avith gray semi-transparent gra-
nulations.
Tubercle in the left hemis-
phere. Greenish tough substance
with granulations in fissures, and
at the base of the brain genei-ally.
Other granulations on upper part
of right hemisphere.
Ventricles,
Three ounces of
limpid serosity.
Two or three tea-
spoonfuls of limpid
serum.
Two ounces of
cleai" serosity.
Three drachms of
limpid serum.
An ounce to two
ounces of milky se
rosity.
An ounce of lini'
pid serum.
Yellowish-white granulations
in left fissure of Sylvius.
Milky aspect of the arachnoid
at the base. No granulations.
Opacity and thickening around
the base of the optic nerves. Yel-
low opaque patch on the upper
part ef the cerebellum.
Yellowish hard granulations
upon the convex surface of the
hemispheres and at the base,along
the vessels.
9*
One to two dra-
chms of serosity.
Three ounces of
limpid serosity.
Greatly distended,
perhaps six ounces
of limpid serosity.
Not distended.
Cerebral Substance
Firm.
Softening of cen.
tral portions. Injec-
tion moderate.
Finn; natural co-
lour.
Septum lucidum,
and fornix soft. In
general firm, and
moderately injected.
Finn; not inject-
Finn; not iniect
ed. ^
Substance of brain
fii-m, except around
a tubercle.
Not softened.
Finn; pale.
NotinJectEd;slight
softening of the cen-
tral parts.
Firm;
jected.
a little in-
102 Gerhard on Cerebral Affections of Children.
12. Cornier, male, 8et.6,
Pia Mater.
Thickening of the arachnoid
at.the base, around the fissure of
Sylvius.
Ventricles.
Much distended by
serosity.
Cerebral substance.
Centrail portion sof-
tened.
13. P^e?'/ie^, female, get. Yellowish substance on each Contain a drachm Central parts and
14. sideof the median line, same sub- of troubled serosity. walls of the ventri
Both lungs filled with stance at the base around the cles in general difflu-
very numerous gray gra- optic nerves, and in the fissures ent,
mlations. Tubercles of Sylvius. Hard granulations
in bronchial glands, kid- upon the whole convex surface of
ney, and small intestine, the hemispheres.
14. Poupart, female,
t. 6.
Cavities and crude tu-
bercles in left lung. ; In
right, numerous tuber-
Tubercles on the upper part of
right hemisphere, witlT gray gra-
nulations on each side of the me-
dian line. Fissures of Sylvius
filled with concrete matter con-
elfs and granulations, taining gray granulations.
Bronchial and mesente-
ric glands tuberculous.
15. Dehaut, female. Tuberculous infiltration and
!t. 4. gray granulations on upper part
Lungs contain tuber- of left hemisphere. Fissures of
cles. Bronchial and me- " " ' '•"'■■' i -•
senteric glands tubercu-
lous.
Sylvius filled with granulations.
16. Pachon, female. Large tubercle in the inferior
set. 5. part of right hemisphere. Tu
Cavei'ns,tubei'cles,and bercles in the pia mater, and gra
jray granulations in both nulations in the fissures of Syl
lung-s. Bronchial and me- vius
senteric glands, spleen
tuberculous.
17. Blondel, male, Two tubercles attached to the
set. 2. cerebellum. Thickening and nu-
Cavern in lower lobe merous granulations in the pia
of right lung; tubei-cles mater of the base,
and gray granulations in
both lungs. Spleen,
bronchial and mesenteric
glands tuberculous.
18. Terard, male,
set. 7.
Lungs and pleurse
filled Avith numerous tu-
bercles. Ganglia tuberr
culous.
19. Sances, female,
set. 6.
Very numerous granu-
lations throughout both
lungs. Bronchial glands
tuberculous.
20. Courtraif, female,
set. 7.
Lungs contain tuber
cles and granulations
Bronchial and mesente
ric glands tuberculous.
Tuberculous masses on each
side of the median line. Granu'
lations in the fissures of Sylvius.
An ounce of trou-
bled serosity.
A drachm of sero-
sity.
Two drachms of
serosity.
Granulations and patches of
yellow substance on both sides of
median line beneath the arach-
noid. Base of the brain including
fissures of Sylvius covered by yel-
lowish substance.
Teliow substance covering the
central parts of the base, and the
fissures of Sylvius; whitish hard
granulations in this substance.
Tubercle on the cerebellum.
Two drachms of
serosity.
Two ounces of se
rosity in ventricles.
Two to three oun-
ces of serosity.
Softening around
the tubercles.
Softening around
the tubercles, and of
the posterior part of
left hemisphere.
Softened in the fis'
sures.
Softened at the
centre and around
the tubercles.
Parietes of ventri-
cles and cortical sub-
stance in contact
with the tubercles
much softened.
21. Ddouche, female,
ast. 5.
Lungs full of miliary
tubercles. Mesenteric
and bronchial glands tu-
berculous.
22. Boudoux, female,
?et. 5.
Cavity in right; tuber-
cles in both. Bronchial
glands tuberculous.
Tubercles on the summit of
both hemispheres. Tubercles and
granulations at the base of the
brain.
Granulations numerous on the
convex surface. Yellow substance
filled with the same granulations
at the base.
Two or three oun-
ces of serosity.
Two ounces.
Not injected; cen-
tral parts softened.
Not softened;
njected.
Central parts sof-
tened.
Cortical substance
at the base flaccid,
but without change
of colour.
Gerhard on Cerebral *^ffections of Children.
103
I. (16. Stamne,) fe-
male, Sit. 4.
Tubercles in pleurse.
Cavities and numerous
tubercles in lungs. Ul-
ceration of larynx. Me-
senteric and bronchial
glands tuberculous.
. Fia Mater.
Tuberculous mass on the right
hemisphere, extending from the
summit to the base.
24. ■, female, set. 7.
Tubercles in pleurae;
tubercles and cavities in
lungs. Bronchial glands
very tuberculous.
Semi-transparent granulations
at the base, in the midst of a te-
nacious transparent substance
which also contains a few opaque
miliaiy tubercles.
Ventricles.
An ounce of limpid
serosity.
An ounce of trou-
bled serosity.
25. Colas, female, st, 4. Yellow substance in the fissures
Tubercles in lungs and of Sylvius,
pleui-ae. Gangha, spleen,
and liver tuberculous
An ounce of limpid
serosity.
26. Noireau, male, Layer of yellow substance in-
sat. 4, terspersed with granulations, co-
Numerous granula- vering the whole base of the brain,
tions in lungs, pleurae,
and peritoneum.
Three ounces of
serosity.
27. Benard, male, set, 7.
Numerous tubercles in
both lungs and pleurae.
Tubercles in gangUa,
spleen, peritoneum, and
kidneys.
28. Kiffer, male, aet. 4
Tubercles in left lung.
bronchial and mesentenc
glands.
29. Latniral, female,
aet. 7.
Viscera not noted.
30. Pincon, female,
aet. 10.
Bronchial glands and
spleen tuberculous, other
viscera not noted.
Granulations and miliai-y tu-
bercles in the fissures of Sylvius
and cerebellum, and to a less
degree on the convex surface of
the brain.
Granulations on the convex
surface of the hemispheres and in
the fissures of Sylvius, without
concrete substance. Tubercle in
the cerebellum.
Opaque miliary tubercles on
the convex surface of the braiUk
Granulations in the fissures, and
tubercles of the size of peas adhe-
ring to the pia mater.
Opaque hard substance around
the optic nerves. Granulations
on the right hemisphere and the
cerebellum.
Cerebral Substance.
"Wallsof both ven-
tricles much soften-
ed.
Parietesof ventri-
cles much softened,
includingthe central
parts.
Firm.
Cortical substance
of the fissures of Syl
vius softened and in-
jected.
Five ounces of
transparent serosity.
Two ounces of
reddish serum.
Firm; not injected
Cerebral substance
a little injected, but
firm.
Half an ounce of
serosity.
An ounce of se-
rum.
Central parts not
softened.
Firm and pale.
I am indebted to my friend M. Rufz for the last six cases of the
thirty which are analyzed in the preceding table. I am in possession
of two other cases which form part of the same series; one is relative
to a child three years old, and the other to one seven years of age|
both girls. In each case the yellow opaque substance so often men-
tioned was found at the base of the brain, with semi-opaque granula-
tions adhering to the arachnoid; in both subjects tubercles existed in
several viscera, and in the elder, the arachnoid, pleura and perito-
neum were nearly covered by numerous gray granulations. The
whole series includes, therefore, thirty-two observations; that is, all
the cases which had been regarded as examples of the affection known
under the names of hydrocephalus acutus and meningitis, and which
had offered on dissection a lesion of the cerebral organs or membranes.
104 Gerhard on Cerebral Affections of Children.
It will be seen that all the subjects, with the exception of Nos. 11
and 12, presented tubercles in other organs than the brain. In case
11, gangrenous cavities were found in the lungs, but no acute tu-
bercles were discovered, so that the origin of these cavities is of
course doubtful; but the existence of perfectly characterized miliary
tubercles in the membranes of the brain proves that the case belongs
to the same class as the other observations. I was not present at the
examination of the case No. 12, I was indebted for a note of the au-
topsy to a friend who omitted to examine all the organs with care.
In every case analyzed, there was evidence of the existence of tu-
bercles in one or more organs; the subjects were therefore all tuber-
culous, that is, offered the circumstances necessary for the formation
of tuberculous matter; this disposition to the general production of
tubercles occurred in no other disease which I observed, than that
now investigated, and phthisis or evident tuberculization. The sub-
stance formed beneath the arachnoid was in many cases evidently
tuberculous, consisting of round, hard, semi-transparent or opaque
yellowish bodies, which presented the usual characters of tuberculous
matter; in other cases these granulations were interspersed through-
out by a homogeneous, semi-transparent, gelatinous matter. This
disposition of the tuberculous granulations, closely resembles the ap-
pearance of a lung infiltrated with tuberculous matter, through which
miliary tubercles are disseminated. Another form of the morbid pro-
duction is, that of a yellow tough substance of consistence and aspect
intermediary between fibrine and tuberculous matter, or not unlike
concrete pus. It is difficult to ascertain the precise nature of this
substance; in several of the subjects I have lately examined, I sub-
jected small portions to microscopical examination, and distinctly
recognised two distinct parts, that is, semi-transparent granu-
lar bodies in the midst of an amorphous matter. Whether the
same distinction of the two substances exists in all cases, is yet to be
decided.
The table indicates the quantity and characters of the serosity
found in the ventricles; it is evident that the effusion of serum is va-
riable in quantity, and far from constituting the necessary character
of the disease.
The cerebral substance was sometimes softened, at others it re-
tained a perfectly natural aspect; the rigidity of the muscles was by
no means confined to the subject which presented the softening of the
brain. Case No. 3 is an example in point.
The question whether this affection is of an inflammatory nature,
excited formerly great interest. M. Guersent was of opinion that it
Gerhard on Cerebral Jiffections of Children. 105
consisted in an inflammation of the membranes. M. Senn adopted
this view. M. Charpentier, who had also observed it at the Chil-
dren's Hospital of Paris, called it a meningo-cephalitis. I have reason
to believe that M. Guersent, to whom the coincidence of tubercles with
this disease had been shown, has now modified his former opinions.
The cases which I have detailed, induce me to regard this form of
cerebral affections as closely analogous to the deposition of tuberculous
matter in other organs. M. Rufz, who prosecuted his examinations
in a separate service of the hospital, and examined with care all the
organs of the children who died while under his observation during
the last nine or ten months of the past year, (1833,) agrees with me
in regarding the weight of evidence as decidedly in favour of the tu-
berculous nature of the affection. Those who may think the evidence
sufficiently strong, may adopt this inference without agitating the
question of the inflammatory or non-inflammatory nature of the dis-
ease. It will then in fact be placed upon the same footing as the for-
mation of tubercles in other parts of the body, and such as are still dis-
posed to regard tuberculous matter as one of the products of inflam-
mation in the one case will be at liberty to extend the theory to the
other. The existence of tubercles does not explain the cause of death;
they constitute simply the anatomical character of the disease; the
morbid actions which precede the anatomical lesions are probably not
always in direct proportion to their effects. Thus, the case of Mayen
presented only a few round tuberculous granulations in the pia mater,
yet we can draw from it no direct inference as to the intensity of
the disease during life.
Next to the development of tuberculous matter, the anatomical
phenomenon of greatest interest is the lesion of the mucous mem-
brane of the stomach. Of the ten cases detailed, six presented an un-
equivocal alteration of this organ.* Of the other cases not detailed,
about four-fifths offered a lesion of the stomach. The alteration of the
mucous coat was sometimes limited to a simple thinning, more rarely
it was thickened, in other cases it was mamillated. In some subjects
the thinning of the membrane was very great, but it was nearly limited
to the great tuberosity and disposed by bands, generally longitudinal,
but sometimes united by transverse lines; these bands contrast by
their bluish tint with the surroundins; membrane. The thinness in
We mean by unequivocal lesion an alteration of thickness or consistence,
or other apparent change of structure; livid punctuated redness may also be re-
garded as a lesion, but the lighter degrees of injection, or the general redness
of imbibition, constitute doubtful evidence of inflammation.
106 Gerhard 07i Cerebral Jlffections of Children,
bands of the mucous membrane seems an undoubted lesion; the gela-
tinous softening may be an appearance produced after death, at least
the question is still doubtful. The thinning of the mucous membrane
is not peculiar to this affection; it occurs in many other diseases, es-
pecially the tuberculous; but some years since, when the physiological
doctrine engrossed so much attention, the alteration of the stomach
was looked upon as a proof of the gastric origin of meningitis.
Symptoms. — One of the first and most constant symptoms was
vomiting,' of the ten cases which I published in the preceding number
of the journal, eight offered this symptom at the commencement, or
during the first days of the affection. In two it was stated not to
have occurred, but the parents of one of the children were possessed
of too little intelligence to render the information received at all
certain. Of four cases, (not published,) in which some details could
be obtained respecting the same symptom, three were accompanied
by vomiting. The inference is clear, that vomiting forms one of the
first symptoms in a large majority of patients affected with this form
of disease.
Cephalalgia This symptom existed in all the cases in which suffi-
cient data could be obtained to ascertain its presence or absence. The
cephalalgia usually continued until succeeded by delirium or coma.
Constipation. — Immediately after the vomiting and cephalalgia, the
dejections either cease or become extremely rare. Case No. 2 offers
the only apparent exception. Stools may sometimes be produced by
the action of a cathartic, but with difficulty; they were not followed
by a notable diminution of the symptoms.
Beliriwn. — A noisy, violent delirium is very rare in this affection.
Nos. 1 and 3 of the cases published are the only instances of it which
I have witnessed, The low muttering delirium is frequent; I have
myself ascertained its existence some days previously to the termina-
tion of the affection, in nearly one-half of the cases which were ad-
mitted. The absence of muttering delirium in a number of cases
could not be satisfactorily established, in consequence of the neces-
sity of relying upon the reports of the attendants of the sick. Moans,
or low plaintive cries of the kind first noticed by M. Coindet of
Geneva, are frequent in the affection when the coma becomes very
profound; they are however by no means characteristic of the dis-
ease. The movement of the lower jaw, (machonnement,) exists in
a large number of cases; it is usually observed at the same time with
the low plaintive cries.
Convulsive movements of one or more muscles were detected in
nearly one-half of the cases, (five in twelve, ) which were examined
Gerhard on Cerebral Affections of Children, 107
on this point. The absence of this symptom cannot be affirmed with
entire accuracy, unless the child had been much more closely ob-
served than is practicable in a large hospital. The spasmodic move-
ments occurred in the earlier or second stages of the disease.
Lesions of the organs of movement. — These were an increased and
permanent contraction of the muscles; or secondly, perfect or im-
perfect paralysis. Of the ten cases published, but one, No. 7, offered
no evidence of permanent contraction of the muscles of either the
face or limbs. Of the other cases, Nos. 1, 5, and 10, presented but
slight traces of rigidity; in all of these cases the quantity of serosity
in the ventricles was remarkably great. Of the cases not published,
two only offered no distinctly marked contraction of the muscles; in
these the same abundance of serum in the ventricles was observed.
The great secretion of serum seems therefore to coincide with the
absence of the muscular contraction observed in the large majority of
cases. The degree of anormal contraction is very various, in some
patients it is observed in the slight distortion of the features without
paralysis, in others there is a little rigidity of the muscles of the
neck, and in the more marked cases, strong contraction of the mus-
cles, always more distinct in the upper than in the lower extremities,
and generally more evident on one side of the body than on the other,
without being strictly limited to either.
The rigidity of the muscles is most easily discovered at the elbow.,
but care must be taken not to mistake the voluntary resistance of the
muscles caused by the annoyance of the child for the permanent in-
voluntary stiffness. At first this distinction is hardly to be made,
except by a careful comparison of both sides of the body. In some
cases the contraction of the muscles is so marked that the limbs are
in a state of permanent flexion, which can only be overcome by a
strong effort.
Paralysis existed in none of the ten cases published, but the power
of voluntary motion vvas greatly dinmiished in all. Perfect paralysis
did not occur unless immediately before death. The sensibility at
first is almost invariably augmented, the increased susceptibility to
impressions is not confined to the muscular system, the senses are
more acute, bright light and loud sounds are both evidently painful;
the same increased susceptibility is betrayed by an aversion to ques-
tions and impatience of the least disturbance. The sensibility in-
variably diminished as the symptoms became more intense, and in
some cases, (three and five for example,) it was extremely obtuse.
The loss of sensibility coincides with the rigidity, unless one side of
the body be in a state of nearly perfect paralysis.
108 Gerhard on Cerebral *^ffections of Children.
Senses,— T\\Q, pupils were generally dilated^ thus, of the ten cases,
in but one were they more contracted than usual, in two others there
was neither evident contraction nor dilatation. Of the other cases
none are noted as presenting the anormal contraction of the pupils;
rather more than half the number offered an evident dilatation. Stra-
bismus existed in a majority of the cases. Loss of sight occurred but
rarely. The hearing was acute, even more so than in the natural
state in the patients who entered the hospital in the earlier periods of
the disease; it afterwards became extremely obtuse.
The intelligence at first offered no deviation from the natural state,
except the increase of vivacity and greater petulance of the child;
but it gradually became dull, and at the same time confused; this
state was replaced by delirium or stupor. Complete coma existed in
many cases before death. The stupor was not unfrequently much
diminished during the course of the disease, sometimes to so great a
degree that the child could understand and answer correctly the ques-
tions proposed to it; this remission is by no means a favourable sign.
The symptoms detailed are those of greatest interest in this affec-
tion, the patients were examined in relation to several other points,
but they are scarcely of sufficient moment to render an analysis ab*
solutely necessary; except of the state of the pulse and the respira-
tion. The pulse it will be seen was slow, 70, 80, or 90 at first, and
through the whole disease until near the termination, when it became
much more rapid; the slowness of the pulse was found in all the cases
which were admitted some days before death; the augmentation in the
number of the pulsations was almost constant, there was but one
exception, (No. 2,) amongst those which I examined. The respira-
tion was at first irregular, neither slow nor much increased in fre-
quency, but accompanied wi,th a peculiar sigh in the expiration; to-
wards the close it became stertorous, more frequent and much more
elevated.
In concluding the sketch of the symptoms the countenance should
not be forgotten; as in this affection it is so peculiar, that the
sister of one of the wards at the Children's Hospital was accustom-
ed to distinguish the disease with much accuracy from the mere as-
pect of the child. The face is pale, with occasional flushes of redness
on one or both cheeks; mouth frequently a little deviated; lips com-
pressed, or half open; the eyelids are almost invariably closed, or a
little separated; nostrils widely dilated. But the most distinctive
character is the peculiar listless expression, with occasional grimaces
and movements of the lips, as if tasting an article of food; this cha-
racter does not admit of description, it must be seen to be appreciated.
Gerhard on Cerebral Affections of Children. 109
Diagnosis. — The disease just described is often confounded with
certain cerebral symptoms, such as convulsions, which are the attend-
ants of affections other than the tuberculous, or produced by some
accidental cause; hence arises the mistake of M. Charpentier, who has
evidently compared this fatal disease which he had observed at the
childrens hospital with different affections which he witnessed in pri-
vate practice; the mortality was necessarily very different in the two
classes. Can the diagnosis be satisfactorily established ? I do not
venture to think so, the question is so difficult that it would be pre-
sumptuous to resolve it hastily. With the existing facts, we may
however attain a greater precision than could have been reached with-
out the aid of pathological anatomy.
I have met with but few diseases resembling this form of cerebral
affection, these are — 1st, the typhoid or nervous fever of Paris; 2d, the
development of an encephaloid mass at the base of the brain; 3d, tu-
bercles in the cortical substance without evident disease of the mem-
branes; 4th, a form of disease which presents closely analogous symp-
toms, but in which I could discover no decided traces of cerebral le-
sion; and 5th, the anomalous symptoms which are often confounded
with this affection.
The typhoid fever may be readily recognised from the existence of
diarrhoea, tympanitis, petechia, sibilant rhonchus, and decided fe-
brile pulse. None of these symptoms are met with in the ordinary
forms of the cerebral affections. The peculiar alteration of the func-
tions of the nervous system is another distinctive mark.
The encephaloid tumour which I found at the base of the brain in
one subject, could only be confounded in symptoms with the isolated
tubercles in the cerebral substance, its chronic duration was sufficient
to distinguish it from the affection of the membranes.
Tubercles are sometimes found imbedded in the cortical substance
of the cerebrum, and more frequently cerebellum, without the ex-
istence of any peculiar symptom during life. In other cases the tu-
bercles are larger or more numerous, and then give rise to distinct
symptoms, such as partial paralysis and rigidity of the muscles; these
cases may be distinguished by their chronic nature, by the gradual
diminution of the intelligence and progressive increase of the symp-
toms. I have collected two observations of this variety, yA\\c\\ it is
not necessary at present to publish. The fourth variety is probably
but a form of the disease described in the observations; the child was
tuberculous, and the symptoms were nearly similar to those observed
No. XXVII.— May, 1834. 10
110 Gerhard on Cerebral Affections of Children.
in othei* patients. The apparent severity was however so much less
than in the other cases, that strong hopes were entertained of the
child's recovery. Was this case an example of the disease before
the secretion of the morbid substance?
The last form of disease which is confounded with the tuberculous
meningitis, is the various complications supervening during the course
of other affections, especially of the alimentary canal. The last
variety is in many instances within the controul of treatment, and by
no means subject to the same laws as the tuberculous disease. The
diagnosis is difficult, but the cases which I have witnessed at the
Children's Hospital were still perfectly distinct. In other instances,
the symptoms seem to be less easily recognised; I am ignorant
whether these simulate the tuberculous affection in all respects.
The diagnosis is then to be founded rather on the succession of the
symptoms, than on the separate existence of any one of them. A
child labouring under a tuberculous disease of the lungs or abdomen,
who should be taken with vomiting, constipation, slowness, and per-
haps irregularity of the pulse, with the disorders of the nervous sys-
tem already enumerated, would be regarded as labouring under this
affection. If the child possess all the appearances of perfect health*
the diagnosis is a little less certain, but still the order of the symp-
toms would in the vast majority of cases indicate the nature of the
disease to be tuberculous meningitis.
Treatment. — All the cases which I witnessed were fatal; the want
of success was not peculiar to the years during which I had observed.
M. Charpentier, who had collected a series of cases eight years pre-
viously, did not see one recovery at the hospital. M. Rufz collected
two cases of cure, which at the time he regarded as examples of the
disease. The case to which I alluded of doubtful disease, seemed
on the point of recovering, and another patient whom I saw before
commencing the series of observations, recovered from the earliest
symptoms^ this child returned to the hospital some weeks afterwards,
and died of tubercles in the lungsj on dissection the membranes of
the brain were evidently thickened, although the precise alteration was
not noted. The bad success of the treatment was not owing to its
want of energy; some of the physicians had tried the most vigorous
antiphlogistic means, others had prescribed purgatives together with
depletion; and blisters were employed in some cases. I did not
witness any attempt to produce rapid salivation by the use of mercu^
rial ointment.
Medicine is necessarily as powerless in the decided cases, as it
Weever's Description of a New (Esophagus Forceps. Ill
is in phthisis or other tubercular affections; but there must be a stage
preceding the development of the anorrnal substance; in this stage
therapeutics may be of utility. I have nothing new to add relative
to the treatment, wiiich can scarcely become more positively lixed
unless the distinction between the several varieties of disease classed
under the term acute hydrocephalus or meningitis, be clearly made
out. But as it is clearly the duty of a physician in treating cases
hitherto incurable, to use those means which seem to offer the greatest
chance of benefit, in making my election I should rely chiefly on
moderate depletion, and an attempt to salivate the child by mercurial
frictions. Very free depletion is not called for in most cases; the
patients are scrofulous, and generally do not well bear a great loss
of blood.*
Art. X. Description of a New (Esophagus Forceps. By Constantine
Weever, M. D. of Detroit.
IT is admitted to be of the utmost importance to remove certain fo-
reign bodies from the oesophagus, such as pins, needles, angular
pieces of bone, &c. as their presence not unfrequently produces dis-
astrous and fatal consequences; yet it is always a matter of consider-
able difficulty to extract them with the usual means, and if those
bodies are situated near the cardiac termination of the oesophagus,
it has generally been found impossible to remove them by the
mouth, and the only alternative has been to thrust them into
the stomach. This want of success appears to depend chiefly
upon the imperfection of the instruments ordinarily employed for this
purpose. Every surgeon who has had occasion to use them, knows
that their employment is a blind and unscientific groping in the dark,
which almost always ends in disappointment.
The above considerations, and a knowledge of the success which
has attended the seizure of urinary calculi by the lithontriptic for-
ceps, led me to construct the following instrument.
* The first part of this article was transmitted from Europe; the proof sheets
were corrected by a friend, who was unable to decypher a few words of the
manuscript; this circumstance will account for some singular verbal errors.
112 Weever's Description of a New CEsophagus Forceps.
It will be readily perceived that this instrument is particularly cal-
culated to remove those articles from the oesopha-
gus which would prove the most dangerous to life
by their presence in the alimentary passages^ pins,
needles, and sharp pieces of bone, are of this class.
These forceps can be easily pressed down the
throat, as the elastic branches accommodate them-
selves to the varying dimensions of the passage,
and if the extraneous body does not come within
their grasp in their first introduction, they must
be withdrawn and the stilet turned one-fourth
round, which will bring the blades of the forceps
at a right angle with their former position,- when
they are again to be passed down, and the object
of search will be seized with much certainty.
When the inner branches pass beyond the foreign
substance, the movement is accompanied by a sen-
sible click, which gives notice that the tube is to
be pressed down a short distance while the stilet
is held stationary; by this means the blades of the
forceps are closely approximated, and whatever is
within their grasp, will be firmly retained, and
may be generally withdrawn without difficulty.
One advantage of this instrument is this, that the
materials of which it is composed, may be obtain-
ed in nearly every country village, and it can be
constructed by any man of ordinary ingenuity. In.
6. An elastic tube. children, a flexible catheter will answer well for
tendhTg'fSjh the^tublf' the tubc, by removing its vesical extremity; and in
firmly S'tolheltUeT^'adu^ the stomach tube, or in its absence, take a
ofXSiTsJ'^tie^'llte^^ of wire of convenient flexibility, two feet in
roundedfandTe inner L' length, put One end of this into a circle about one-
maS^Vukft^SeSdof^^S'^^^^ ^^ ^^ ^"^^^ ^^ diameter, and then bend this
a common forceps. circle to a right angle with the shaft of the wire.
This will serve every purpose for compressing the blades of the forceps.
The springs or forceps proper can be admirably constructed from
the mainspring of a watch, by moderately heating it in the blaze of a
lamp at the points where it is intended to make the acute angle, and
form the internal branches.
Detroit^ January 15th, 1834.
[Note. — Mr. George P. Schively, an ingenious surgeon's in-
strument-maker of this city, to whom we communicated the preced-
I
SomeYVSLil on Ca7nphor,4'C. in Suppression of Urine. 113
ing article, has made an instrument, which is very accurately repre-
sented in the accompanying figure. This instrument differs slightly
from that described by Dr. Weever, in the blades of the forceps be-
ing nearly straight instead of curved; and in their being of a some-
what oval form instead of flat. These we conceive to be consider-
able improvements, as this instrument will be less likely than the
original one to pass a foreign body in the oesophagus when the body
is slender, as a pin or needle, or fish-bone; and also will not be lia-
ble to catch hold of the oesophagus. — Editor.]
Art. XL On the Efficacy of a Mixture of Camphor and Muriate of
Ammonia in the Treatment of Suppression of Urine, By Alex-
ander SoMERVAiL, M. D. of Loretto, Essex County, Virginia.
^SUPPRESSION of urine is often produced from the situation of pa-
tients preventing them from evacuating the bladder when it is de-
manded, and they continue to suffer until they are at liberty, and
then the power of evacuation is lost. The bladder, from over-disten-
sion, is paralyzed, and the sufferings of the patient go on increasing.
The catheter is the usual and effectual remedy, and this must be re-
peated twice a day, till the lost power of evacuation is restored.
"With those patients which I have had, this has never returned till
'th€ end of the seventh day from the first introduction of the catheter,
and never before, unless it has been used in a few hours after the re-
tention began. I have had many cases so as to ascertain this, and
been a witness of much suffering, and one death because the parts
became inflamed and the catheter could not be introduced. I have
heard of several deaths from the same cause, and such must often be
the case. Since the use of elastic catheters, there is less danger
when they can be introduced, because they can remain in for some
days, and are easier introduced again. This I have done several
times, still it is painful, and even dangerous, under many circum-
stances, and an easier remedy is desirable. This has been put in my
power, as I think the following cases prove.
In September, 1830, 1 had a patient, a black woman, who was suffer-
ing from fever, attended by suppression of urine; of this latter affection
I was not told. She recovered in a week. In October, 1831, she had a
child, and an entire suppression of urine took place about two week^
afterwards. As usual, I told her I must use the catheter. She then said,
cannot you give me the same medicine you gave me last year? I got
well directly. On Inquiry, she said she was then in pain from the same
10^:
114 Somervail on Camphor, (§'C. in Suppression of Urine.
cause and the medicine then given for the fever renioved it. I gave her
the mixture then used, which consisted of three grains of camphor
and five grains of muriate of ammonia, made into an emulsion with
gum Arabic, taken every two hours. Next day the suppression was
removed, and did not return.
In April, 1832, an elderly free mulatto woman was much swelled
from dropsy, the breathing distressing, and in the last days of preg-
nancy. She took an infusion of digitalis, which relieved the breath-
ing: next day she was delivered. The infusion was left off, expect-
ing all would pass off as usual. In a day or two the dyspnoea return-
ed and the swelling continued. The digitalis was again given. It
operated effectually^ the breathing was relieved, the urine flowed in
abundance, and the swelling disappeared. In the afternoon she dis-
obeyed the call to make water, and suppression followed. I gave the
camphor and sal ammoniac, as in the other case. In the evening she
was a little relieved, the urine passed afforded relief. She only took
three doses, a neighbour persuading her parsley root tea was better.
I then urged her to take the mixture every two hours; this she did
faithfully, and continued it for two days, and was completely re-
lieved. She was then taken with frequent calls, accompanied with
straining and ardor urinee; the bladder empty. She was directed to
drink half a pint of water every half hour till this was better, which
was soon accomplished, and no more difficulty.
In October, 1833, a white woman, advanced in years, and who had
been long sick, was overtaken with suppression of urine for several
days, the bladder much distended, and suffering as usual. She took
the same mixture, and was relieved that same day. Next day no
obstruction remained, and this did not return.
On the 20th of January, 1834, I saw another white woman, the
mother of a large family, who suffered for several days as usual. I
gave her the mixture^ she was at ease in half an hour. On the 3d
of February, she was again in the same situation. I gave her the
camphor only, thinking that was the active medicine. This she took
that day and the next, growing worse all the time. In the morning
she sent to me, stating her sufferings, I sent the sal ammoniac to mix
with the camphor. The day after I w^ent to see her. She said after
the second dose she was quite relieved, and continued so. She had
no sleep for three nights from suffering, but this night she slept so
profoundly that those with her thought she was dead.
When I got home to-day, I found the daughter of a woman who had
suffered in this way a year ago, and was relieved by the mixture^
She was now again getting bad, and requested the same medicine?
Gillespie's Cases of Neuralgia. 115
which I sent, and saw her next day. She was better, but had only
taken one dose, because it made her sick. I gave the sal ammoniac
by itself, which did very well. This was not suppression, only dy-
suria, but the first attack was suppression.
Loretto, Essex County, Virginia, March 15th, 1834.
ArTo XII. Cases of Neuralgia with Bemarks. By W. A. Gillespie,
M. D. of Louisa, Virginia.
IT is not perhaps sufficiently well-known to the members of the me-
dical profession, that tooth-ache, and what is vulgarly called jaw-ache,
are frequently of neuralgic character and of miasmatic origin.* Many
cases of this kind are submitted to the manual dexterity of some
neighbouring mechanic, who extracts tooth after tooth, until at
length the disconsolate sufferer, without experiencing the least
relief, frequently abandons himself, in despair, to the most ex-
cruciating agony. Several cases have come under my observation,
in which perfectly sound teeth have been removed, and often several
in succession in consequence of no relief being afforded from the ex-
traction of the first. In addition to this, tooth-ache drops of
various kinds, many of which contain mineral acids, are used by
the tormented sufferer in profusion, to the eventual destruction
of his few remaining instruments of mastication. I am by i\o
means opposed to the extraction of teeth, in proper cases, with due
discrimination and reference to collateral circumstances. Carious,
useless teeth should always be removed; but under scarcely any cir-
cumstance would I be disposed to remove a sound useful tooth. When
odontalgia is produced by slight caries, complete success has been
known to follow the mere starting of the tooth from the socket by the
instrument, and immediately pushing it back into its natural position,
thus destroying its nervous connection, whilst the tooth adhered firmly
to the socket, and answered, in a good degree, the purpose for which
it was intended. The following cases exemplify the success of qui=
nine in neuralgic odontalgia. Notwithstanding the labours of many
late writers, the pathology of neuralgia is still involved in much ob-
scurity; but 1 believe no remedy, as a general one, is preferable to
the sulphate of quinine. Many cases that were formerly termed
rheumatism, ought manifestly to be classed with neuralgia; it is in
* M*Culloch, Bell, Sec.
116 Gillespie's "Cases of Neuralgia.
this way only that we can account for the many high encomiums passed
on the Peruvian bark, as a remedy in acute rheumatism, by Drs.
Hugh Smith, George Fordyce, Dr. Haygarth, &c.
Case I. July ^9th. — Mrs. S. had been subject to violent tooth-
ache, or jaw-ache as she termed it, for three months^ during this time
she had applied to a mechanic who had extracted at different periods
three sound teeth. No relief being afforded it was thought proper to
have professional aid, and accordingly I was called to the patient a
few hours after the extraction of the third tooth. It was one of the
large molares of the upper jaw, perfectly sound, and its removal had
had no effect on the pain, which was of that lancinating, shooting cha-
racter, too intolerable almost to be borne, at least not without the
greatest fortitude. Upon inquiry, finding the, pain to have regular
periodical exacerbations, and knowing the patient to be exposed to
the miasms of a marsh which had produced in the same season some
violent cases of remittent and intermittent fever, I viewed the dis-
ease as of miasmatic origin, and prescribed sulphate of quinine in free
doses. There was in a short time a suspension of the paroxysms,
and the patient, on account of the disagreeable taste of the quinine
which was given in solution, discontinued its use.
August 15^/i.— The paroxysms of pain had now returned more
severe than usual, I was again called to the patient, and again pre-
scribed quinine which was not taken as directed, and on 20th I saw
her again. I now prepared some pills of quinine, and represented to
the patient the absolute necessity of taking them constantly and re-
gularly, and predicted with confidence almost certain relief from
her excruciating torments. She now took the medicine as pre-
scribed regularly, and had the satisfaction of informing me during the
same week that she had escaped the periodical returns of her distress-
ing complaint, and was now well satisfied that the medicine had con-
trolled it. She has since had no return of it.
Case II. 6'e/3/em6er28/7i.— I was called to Mrs. K. residing in the im-
mediate vicinity of the foregoing case, and exposed to the same miasms.
She had suffered for two months with tooth-ache as she termed it^
and had had two teeth extracted, both perfectly sound, with no re-
lief; and having heard of the preceding case, she now concluded her's
to be a similar one, which I found on examination to be the fact^
Quinine was prescribed as above, and in a few days entire and per-
fect relief followed. Fomentations, blisters and purgatives had pre-
viously been used in this case with no perceptible relief.
She has since had no return.
.Ellisville, December 15th, 1833.
( 117 )
REVIEWS.
Art. XII I. Experiments and Observations on the Gastric Juice, and
the Physiology of Digestion. Bj William Beaumont, M. D.
Surgeon in the tFnited States' Army. Plattsburgh, 1833. 8vo.
pp. 280.
Notwithstanding the numerous treatises on digestion with
which our medical libraries abound, and the extensive and repeated
series of experiments that have been performed, within the last sixty
years, in order to determine the nature of the changes which the food
undergoes in the stomach, and the manner in which those changes
are effected, but little satisfactory was known in relation to this im-
portant part of human physiology until a very recent period. Previ-
ously, indeed, to the publication in 1825 of the experiments of Tie-
DEMANN and Gmelin, of Heidelberg, and the contemporaneous ones
of Leuret and Lassaigne of Paris, almost everything in relation to
the subject was involved in doubt and obscurity. By the investiga-
tions of these gentlemen many facts have been fully established, and
not a few obscurities removed. But as important as have been the
results of their labours, they are very far from affording the materials
necessary for framing a clear and satisfactory theory of digestion.
The fact is, that the investigation of this process is attended, under
ordinary circumstances, with difficulties it is scarcely possible to sur-
mount. Experiments in relation to it are necessarily performed upon
the lower classes of animals, and they are consequently always liable
to more or less error: while it is impossible to multiply them, upon
the same subject, to the extent that is necessary, in order to study
the successive changes which the food undergoes during chymifica-
tion, as well as other important particulars in relation to the process,
without deranging the regular healthy actions of the stomach. Hence
all experiments performed upon living animals are to a certain extent
inconclusive; upon certain points connected with the process of diges-
tion they throw no light whatever. As was long since remarked by a
very sensible writer on stomachic digestion* —
** To arrive at any thing like positive conclusions in regard to this subject,
the experimenter must be enabled to inspect the interior of the healthy sto-
* Raynier, De Digestione in Ventriculo, 1792.
118 Beaumont on Digestion.
mach whilst its functions are going" on, and study there the modifications which
the composition of the alimentary bolus undergoes, from its entrance through
the cardia until its final escape by the pylorus — we shall then, but I fear not
before, be able to say what is the nature of digestion, and what are the powers
by which it is effected."
The opportunity here required, the occurrence of which was no
doubt thought impossible by the writer just quoted, has actually been
furnished to Dr. Beaumont, whose observations and experiments on
digestion constitute the subject of the work before us. By a surgical
case, nearly unique in its results, the interior of the stomach, in
a state of health, and in the perfect performance of its functions, has
been laid open to his view, and he has been enabled to study daily,
for a series of year^, the actions of that important organ— to mark
the successive changes produced in the food during the process of di-
gestion, and to determine with accuracy the composition and proper-
ties of the gastric fluids, and their effects upon the different kinds of
aliment in ordinary use. With a laudable degree of zeal and indus-
try. Dr. Beaumont has improved an opportunity for successfully in-
vestigating the process of digestion, which no inquirer ever before,
or perhaps will ever again possess; and the results of his investigations
are, as will readily be presumed, in the highest degree interesting.
He has not, it is true, made any important discovery, but he has
been enabled to settle conclusively many points which have hereto-
fore been subjects of dispute, and to throw very considerable light
upon others in relation to which our views were formerly vague and
confused. The report of his experiments and observations constitutes,
unquestionably, in many particulars, the most important work ever
published on the physiology of digestion. But while we freely con-
cede to it this, as we believe, merited degree of praise, we must, at
the same time, be permitted to say, after a very careful and repeated
perusal of the work, that we have been not a little disappointed in
finding that so much is left in regard to the process of digestion still
uninvestigated. With the peculiar facilities for studying the subject
in its fullest extent, possessed by Dr. B., he has certainly effected
far less than we had anticipated. His experiments so far from solving
the two great problems in regard to the physiology of the stomach;
namely, 1st, in what does chymification consist, and 2d, in what
manner is it effected?; leave the first in all the obscurity it was before
involved. Dr. B. has been evidently called, by circumstances, to the
performance of a task, with little of that preparation so essential for
its accomplishment. He appears not to have taken sufficient pains to
become acquainted with the labours of his predecessors and contem-
Beaumont on Digestion^ 119
poranes in the same field of investigation. Had he studied with at=
tention the experiments, at least of Chaussier and Montegre, and
the more recent ones of Tiedemann and Gmelin, and Leuret and
Laissaigne, he would have avoided one or two errors into which he
has fallen when alluding to the actual state of our knowledge on the
subject of digestion, while a variety of comparative experiments
would have been suggested to him, the result of which would have
tended, in a very great degree, to settle certain disputed points in
regard to the real action of the gastric fluid; experiments which can
be performed, in a satisfactory manner, only with the peculiar facili-
ties which he possessed. The doctor is also, unfortunately, devoid of
that proficiency in the details of practical chemistry which is all-im-
portant in conducting experimental investigations into the action of
the gastric juice, and into the process of digestion generally. Had
he been able to test, by a careful analysis, the changes which the
food undergoes during its conversion into chyme, and compared
these with the changes induced in it by the action of the gastric juice out
of the body, he might, in all probability, have been enabled to claim the
honour of having fully and satisfactorily explained the mode in which
stomachic digestion is effected; he would, at least, have set at rest
the dispute which exists between those physiologists who refer chymi-
fication to the vital action of the stomach, aided by the solvent powers
of the salivary and gastric fluids, and those who maintain that it is
to be ascribed solely to a specific solvent secreted by the vessels of
the stomach.
We do not wish to be understood by these remarks as detracting
the least from the high praise we have already bestowed upon the la-
bours of Dr. Beaumont. These are unquestionably all-important — and
have advanced, in a very great degree, our knowledge of one of the
most important of the animal functions; giving to us facts in relation
to numerous particulars where before we were in possession of merely
plausible hypotheses. All we regret is, that the peculiar advantages
possessed by Dr. B. for studying the process of digestion, had not
fallen to the lot of some one better qualified, in certain respects, for
deriving from them all the advantages to physiology they were so well
calculated to aiford.
We have every confidence in the good faith in which the experi-
ments of our author were performed, and the accuracy with which
they are reported. He appears, however, to have been too firmly
prepossessed with the idea, that in order to convict of error those
who deny the validity of the deductions drawn, by the majority of
physiologists, from the experiments heretofore performed in relation
120 Beaumont on Digestion.
to the subject of digestion, all that was necessary was to establish the
fact of the solvent powers of the gastric juice. His having overlooked
the real points in dispute between these gentlemen, and such as ad-
vocate the existence of a specific chemical solvent, as the agent of
chjmification, has led him to denounce all who dissent from the opi-
nions of the latter, as " men of vivid imaginations, and great povvers
of mind," who " become restive under the restraints of a tedious and
routine mode of thinking, and strike out into bold and original hypo-
theses to elucidate the operations of nature, &c.;" who are ''averse
to the slow and tedious processes by which truths are attained." To
whose " notions of unrestrained genius — the process of developing
truth, by patient and persevering investigation, experiment and re-
search, is incompatible^" and who advance heresies for "the grati-
fication of a morbid desire to be distinguished as the propagators of
new principles in philosophy, or as the head of a new sect. " When
Dr. Beaumont employed this language he was certainly unaware,
that on the list of the denounced are to be found the names of several
of the most cautious and laborious investigators among the physiolo-
gists of this country and of Europe; and that the greater number, so
far from denying the solvent powers of the gastric fluids, have per-
formed numerous experiments to prove the fact. But even admitting
that Dr. B. had succeeded in proving their opinions in regard to di-
gestion to be erroneous, he should have recollected that no one of
them possessed the advantages for investigating satisfactorily the sub-
ject, which accident has placed at his command; their rejection of
conclusions drawn from experiments so inconclusive and contradic-
tory as those that have heretofore been performed in relation to sto-
machic digestion, is rather to be viewed as an indication of philo-
sophic caution, than as a fondness for bold hypothesis. But the fact
is, the incorrectness of the views of these gentlemen, in many respects
at least, is still far from being established: and here we may sug-
gest to Dr. B. that he can claim no credit whatever for the opportu-
nity he possessed for pursuing the course of experiments detailed in
the work before us, but only so far as he has improved that opportu-
nity for the advancement of knowledge.
In our examination of the work before us, we shall endeavour to
present to our readers a clear view of the facts and deductions of the
author, with an occasional comment upon some of the opinions which
he has advanced. We shall follow, however, a somewhat different
arrangement from that adopted by Dr. Beaumont.
The subject upon which the experiments of the latter were per-
formed, is a young man, of a good constitution, robust and healthy.
Beaumont on Digestion, 121
who, on the 6th of June, 1822, he being then eighteen years of age,
was accidentally wounded by the discharge of a musket loaded with
buck-shot. The load entered his body posteriorly, and in an oblique
direction, forwards and inwards, literally blowing off a portion of
the integuments and muscles of the size of a man's hand, fracturing
and carrying away the anterior half of the sixth rib; fracturing the
fifth; lacerating the lower portion of the left lobe of the lungs and
the diaphragm, and perforating the stomach. On examination, twenty-
five or thirty minutes after the accident, a portion of the lung, as
large as a turkey's egg, was found protruding through the exterior
wound, lacerated and burnt, and immediately below this, was ''an-
other protrusion, which, on further examination, proved to be a por-
tion of the stomach, lacerated through all its coats, and pouring out
the food" that had been eaten in the morning " through an orifice
large enough to admit the forefinger."
It is unnecessary, on the present occasion, to follow out the surgi-
cal details of the accident and its treatment. For seventeen days
every thing that was taken by the mouth soon passed out at the
wound, and the only manner in which the patient was sustained was
by nutritious injections per anum. During this period alvine evacua-
tions could not be obtained, notwithstanding cathartic enemata were
given, and various other means adopted to promote them. As soon,
however, as compresses and adhesive straps could be applied over
the opening into the stomach, and food was retained in the latter, by
the aid of purgative injections, a very hard, black, fetid stool was
procured, followed by several similar ones; after which the bowels
became quite regular, and continued so.
"No sickness, nor unusual irritation of the stomach, not even the slightest
nausea, was manifest during the whole time; and, after the fourth week, the
appetite became good, digestion regular, the alvine evacuations natural, and
all the functions of the system perfect and healthy.
"By the adhesion of the sides of the protruded portions of the stomach to
the pleura costahs and the external wound, a free exit was afforded to the con-
tents of that organ, and effusion into the abdominal cavity was thereby pre-
vented."
Cicatrization and contraction of the external wound commenced in
the fifth week; the stomach became more firmly attached to the
pleura, but the orifice still remained open. This resembled, in every
thing but the absence of a sphincter, the natural anus, with a slight
prolapsus. At every dressing it allowed the contents of the stomach
to flow out, in proportion to the quantity recently taken, a^d when
No. XXVII. —May, 1834. 11
122 Beaumont on Digestion.
the stomach was empty, or nearly so, a partial inversion would take
place, unless prevented by the application of the finger.
** Frequently, in consequence of the derangement of the dressing", the invert-
ed part would be found of the size of a hen's egg-. No difficulty, however, was
experienced in reducing it by gentle pressure with the finger, or a sponge wet
with cold water, neither of which produced the least pain.
*' In the seventh week — the circumference of the external wound was at
least twelve inches, and the orifice in the stomach nearly in the centre, two
inches below the left nipple, in a line drawn from this to the point of the left
ilium."
The food and drinks taken into the stomach were prevented from
escaping through the perforation by a compress and tent of linen kept
on by adhesive strips.
By the 6th of June, 1823, one year from the occurrence of the ac-
cident, the injured parts were all sound and firmly cicatrized, with
the exception of the perforation leading into the stomach, which was
about two and a half inches in circumference. From this time the pa-
tient continued gradually to improve in health and strength, and the
newly-formed integuments became more and more firm.
" At the point where the lacerated edges of the muscular coat of the sto»
mach and intercostal muscles met, and united with the cutis vera, the cuticle of
the external surface, and the mucous membrane of the stomach approached each
other very nearly. They did not unite, like those of the lips, nose, &c. but left
an intermediate marginal space, of appreciable breadth, completely surround-
ing the aperture. This space is about a line wide, and the cutis and nervous
papillse are unprotected, and as sensible and irritable as a bhstered surface
abraded of the cuticle. This condition of the aperture still continues, and con-
stitutes the principal and almost only cause of pain or distress experienced
from the continuance of the aperture, the introduction of instruments, &c. in
the experiments, or the exudation of fluids from the gastric cavity."
Compresses and bandages were constantly demanded, to prevent
the escape of the food from the stomach, until the winter of 1823-4|
at this period a small fold or doubling of the inner coats of the sto-
mach appeared, forming at the superior margin of the orifice, slightly
protruding, and increasing in size until it filled the aperture. This
valvular formation adapted itself to the opening into the stomach, so
as completely to prevent the efilux of the gastric contents when the
stomach is full, but was easily depressed by the finger. When the
stomach is empty it plays up and down simultaneously with the res-
piratory muscles.
In the spring of 1824 the individual had perfectly recovered his
natural health and strength. The aperture in the stomach still re-
mained, but the surrounding wound was firmly cicatrized to its
Beaumont on Digestion^ 123
edges. From this period to the present time he has enjoyed general
good health. He has been active, athletic, and vigorous; exercising,
eating and drinking like other healthy and active people. For the
last four months, (of the autumn of 1833,) he has been unusually
plethoric and robust, though constantly subjected to a continued se-
ries of experiments on the interior of the stomach; allowing to be in-
troduced or taken out, at the aperture, different kinds of food, drinks,
various instruments, and the different contents of the stomach, al-
most daily, and sometimes hourly.
The perforation through the coats of the stomach is situated about
three inches to the left of the cardia, near the left superior termina-
tion of the great curvature. On pressing down the valve when the
stomach is full, the contents flow out copiously.
" When the stomach is nearly empty and quiescent, the interior of its cavity
may be examined to the depth of five or six inches if kept distended by artifi-
cial means; and the food and drinks may be seen entering, if swallowed at this
time, through the ring- of the oesophagus. When entirely empty, the stomach con-
tracts upon itself, and sometimes forces the valve through the orifice, together
with an additional portion of the mucous membrane^ which becomes completely
inverted, forming a tumour as large as a hen's e^^. After lying on the left side,
and sleeping a few hours, a still larger portion protrudes, and spreads out over
the external integuments, five or six inches in circumference, fairly exhibiting
the natural rugee, villous membrane, and mucous coat (?) lining the gastric ca-
vity. This appearance is almost invariably exhibited in the morning, before
rising from bed."
Dr. Beaumont commenced his first series of experiments in May,
1825; in the month of August ensuing, the young man, upon whom
they were performed, returned to Canada, of which place he was a
native, where he remained four years. In August, 1829, he came
again to the United States, and entered into the service of Dr. B.
when the latter commenced a second series of experiments, and con-
tinued them uninterruptedly until March, 1831. Soon after this pe-
riod, circumstances made it expedient for the subject of the experi-
ments to return, with his family, again to Canada. In November,
1832, he once more came back and engaged himself to Dr. B. for
twelve months, for the express purpose of submitting to another se-
ries of experiments, which were performed on him at Washington,
and continued to March, 1833. In July of the same year, a fourth
series of experiments were commenced at Plattsburgh, New York,
and completed on the first of November, 1833.
" The usual method of extracting the gastric juice, for experiment, is by
placing the subject on his right side, depressing the valve within the aperture,
introducing a gum-elastic tube, of tlie size of a large quill, five or six inches
124 Beaumont on Digestion.
into the stomach, and then turning him on the left side, until the orifice be-
comes dependent.
" On introducing the tube, the fluid soon begins to flow, first by drops, then
in an interrupted, and sometimes in a short continuous stream — Moving the
tube about, up and down, or backwards and forwards, increases the discharge.
The quantity of fluid ordinarily obtained is from four drachms to one and a half
or two ounces, varying with the circumstances and condition of the stomach.
Its extraction is generally attended by that peculiar sensation at the pit of the
stomach, termed sinking, with some degree of faintness, which renders it ne-
cessary to stop the operation. The usual time of extracting the juice is early in
the morning, before eating, when the stomach is empty and clean."
The fluid obtained in this manner, when unmixed with any thing
excepting a portion of the mucus of the stomach, with which it is
perhaps always combined, is clear and transparent, inodorous, a lit-
tle saltish, and very perceptibly acid to the taste; having the fla-
vour, when applied to the tongue, of thin mucilage slightly acidulated
with muriatic acid. It is readily difiusible in water, wine, or spirits^
slightly effervesces upon the addition of alkalies; possesses the pro-
perty of coagulating albumen in an eminent degree; is powerfully an-
tiseptic, checking the putrefaction of meat, and effectually restoring
the healthy action when applied to old, foetid sores, and foul ulcerat-
ing surfaces. When not separated by filtering, the mucus combined
with the fluid, gives to it a degree of ropiness, but soon falls to the
bottom in loose, white flocculi. Saliva imparts to the gastric fluid an
azure tinge and frothy appearance.
Equal parts of the gastric fluid and alcohol, mixed together and
agitated, produced a turbid, milk-white fluid, upon the surface of
which, after standing at rest, was formed a thin, white coat of fine,
loose coagula. When the alcohol was first added to the fluid, and
before the two were mixed by agitation, the latter settled to the bot-
tom while the alcohol remained on the top, indicating that its spe-
cific gravity was less than that of the fluid.
The sensible properties of the gastric fluid are changed by a va-
riety of circumstances; as by the admixture of saliva, water, mucus,
and occasionally bile, perhaps, also, pancreatic juice. Derange-
ment of the digestive organs, slight febrile excitement, fright, or any
sudden emotion of the mind, occasions, also, material alterations in its
appearance. Excess in eating causes a rancid state of the fluid, by
which its solvent action is retarded. Dr. Beaumont conceives, how-
ever, that the special solvent itself — the gastric juice—As probably,
"invariably the same substance." The correctness of this latter opi-
nion, the experiments before us are far, however, from establishing.
It would be an interesting inquiry, which we are somewhat sur-
Beaumont on Digestion. 125
prised Dr. B. has never thought of instituting, to ascertain whether
the composition of the gastric juice is not varied according to the
kind of aliment to which the individual is confined. According to
MM. Chaussier, Virey, Pinel, and Voisin, the properties of the
solvent fluid secreted bj the stomach differ in different classes of
animals, and in the human subject at different periods, and that this
difference has a direct relation to the nature of the food. The firsr
mentioned gentleman states, that its acidity is the greatest in her-
bivorous animals, the least in the carnivorous.
In regard to the composition of the gastric fluid, a portion exa-
mined by Professors Dunglison and Emmett was found to contain
free hydrochloric and acetic acids, phosphates and hydrochlorates, with
bases of potassa, soda, magnesia, and lime, and an animal matter so-
luble in cold water, but insoluble in hot. The existence of free hydro-
chloric acid in the gastric fluid was also evinced in the portion exa-
mined by Professor Silliman; in all other respects, however, the
analysis of the latter gentleman is any thing but satisfactory.
The result of Professors Dunglison and Emmett's analysis corres-
ponds very nearly with that of Tiedemann and Gmelin, who found
the gastric fluid to contain, besides mucus, osmazome, and salivary
matter, hydrochloric and acetic acids, alkaline sulphates and hydro-
chlorates, the alkali being chiefly soda; phosphate and muriate of lime
and other salts in minute proportions.
Leuret and Lassaigne state the component parts of gastric juice to
be water, hydrochlorate of ammonia, chloride of sodium, mucus, an
animal principle soluble in water, phosphate of lime and lactic acid;
they deny, however, the existence in it of free hydrochloric acid.
Now, as the lactic acid of Leuret and Lassaigne has been shown
by Eerzelius to be merely a variety of the acetic, the existence of
the latter in gastric juice may be considered as settled ,* while
the researches of Prout, Children, Graves, Tiedemann and
Gmelin, borne out as they are by the analysis of Dunglison, Em-
met, and Silliman, establish likewise, we conceive, beyond the pos-
sibility of doubt, the presence of the hydrochloric acid in a free
state.
The solvent power of the gastric juice, in relation to which so
much doubt and uncertainty have heretofore existed, is proved in the
most conclusive manner by Dr. Beaumont. It can never again be-
come a subject of dispute. Almost every variety of alimentary mat-
ter, whether animal or vegetable, when submitted to the action of the
fluid taken from the stomach, and kept at a temperature of about
100° Fahrenheit, was found to become, in a few hours, completely
11*
126 Beaumont on Digestion.
softened and reduced to a paste, resembling very nearly the contents
of the stomach a short period after the same kinds of aliment had
been eaten. The rapidity with which the substances were dissolved
by the gastric fluid out of the body, was always in proportion to the
purity of the fluid, and the tenderness of fibre and state of minute
division of the substances submitted to its action. Milk and liquid
albumen were found invariably to be first coagulated by the gastric
fluid and then dissolved. The solution of only a certain proportion
of any given aliment was effected by a certain quantity of gastric
juice. Thus it was found, in many experiments, that the articles sub-
mitted to the action of the fluid taken from the stomach became soft-
ened or dissolved to a certain extent, when all further change would
cease; but when more gastric juice was added, the process of solution
would again commence. Cold gastric juice was found to be almost
entirely inert. In one experiment, a piece of roasted beef was sub-
mitted to the action of the fluid placed in the open air at a tempera-
ture of S4°j after twenty-four hours it was not in the least dissolved.
The temperature of the fluid being now raised to 100°, the process of
solution commenced and advanced regularly.
A curious fact is shown by the experiments of Dr. B. ; that food^
namely, taken from the stomach a short time after it has been eaten
and thoroughly mixed with the gastric juice, will become completely
dissolved, provided it be kept at a temperature of 100°.
Dr. B. has found that the gastric fluid undergoes little or no change
when kept in vials for a length of time. On the 1st of November,
1833, he added to one ounce of the fluid taken from the stomach
eleven months before, and which was as pure as when first extract-
ed, thirty grains of lean mutton, boiled and masticated. The whole
being placed in the axilla for six hours, sixteen grains of the meat be-
came dissolved; the solution presenting the usual appearance of
chyme.
The period, as well as the quantity of gastric juice required for
the solution of different alimentary substances out of the body varied,
as we have already remarked, according to the density of their tex-
ture, and their state of division. Sago and tapioca, boiled, were dis-
solved completely in about 3 hours and 15 minutes; fresh wheat
bread in 4 h. 30 min. ; milk, boiled, in 4 h. 15 min. ; unboiled, in 4 h.
45 min. ; gelatine, boiled, in 4 h. 45 min. ; hard-boiled eggs, in 8 h. ;
soft-boiled, in 6 h. 30 min.; oysters, raw and entire, in 7 h. 30 min.;
stewed, in 8 h. 25 min.; beefsteak, in 8 h.; boiled beef, in 9 h. 30
min.; raw pork, in 8 h. 30 min.; fresh mutton, boiled, in 8 h. 30 min.;
beef suet, boiled and entirej in 12 h. j mutton suet, boiled and di-
Beaumont on Digestion. 127
vided, 10 li.^ cream, 25 h. 30 niin.; olive oil, 60 h.; apples, raw and
entire, 18 h.j masticated, 8 h. 30 min.j turnips, boiled and entire,
13 h. 15 min.; raw, 18 h. ; boiled potatoes, entire, 14 h.; mashed, 8
h. 30 min.; boiled parsnips, mashed, 6 h. 45 min.j entire, 13 h. 15
min.; raw and entire, 16 h.; raw cabbage, masticated, 12 h. 30 min.;
boiled, 20 h.; mellow peach, cut small, 10 h.^ mashed, 6 h. An en-
tire portion of boiled tendon required 24 h. for its solution; when
masticated, 12 h. 45 min.; a portion of boiled cartilage, divided, 12
h.; masticated, 10 h. ; and a solid piece of bone, boiled, 80 h. In the
above experiments the quantity of gastric juice employed was one
ounce nearly to a drachm of the article submitted to its action.
By the above statement it will be seen that fat and oily food was
among the articles which presented the greatest resistance to the sol-
vent powers of the gastric fluid; this Dr. B. found to be invariably
the case, as well in the stomach as out of it. Some of his experiments
would seem to indicate that the digestibility of this species of food is
facilitated by a slight admixture of bile with the gastric juice, and
that, very generally, when aliment containing any quantity of fat is
eaten, bile is very generally found in the cavity of the stomach.
We felt extremely desirous of comparing the observations of our
author in relation to the changes produced, in the healthy process of
digestion, upon the different alimentary substances, with those of
Tiedemann and Gmelin, by whom this subject has been examined
with uncommon care and minuteness; but the want of precision m
the description given of those changes by the former, and the entire
.absence of any thing like chemical analysis, prevent this from being
done in a manner calculated to lead to satisfactory results. Taking,
however, the articles albumen, gelatine, new cheese and bone, we
shall give first the observations of the German experimenters, and
then subjoin those of Dr. Beaumont.
Tiedemann and Gmelin found, that in the natural process of diges-
tions, liquid albumen forms a homogeneous fluid, in which the albu-
men remains entirely unchanged; this species of chyme, they re-
mark, passes the pylorus more rapidly than any other. Coagulated,
albumen they found to be much more slowly dissolved; the fluid
formed possessing the properties of coagulated albumen dissolved in
acetic acid.
Gelatine they found to be converted into a clear brownish fluid, in
which neither gelatine nor albumen could be discovered.
New cheese, according to these gentlemen, forms an opaque, dirty-
white fluid, which contains much animal matter, which is neither
casein, gelatine, nor albumen.
128 Beaumont on Digestion,
Bones, in their experiments, formed a liquid, which contained not
only animal matter, but also a large amount of lime.
The following observations in regard to the changes produced in
the same substances, are derived from the experiments of Dr. Beau-
mont, performed, in the majority of cases, with the gastric juice out
of the body; with the general statement that they resembled very
nearly the changes which similar aliment was found to undergo when
submitted to the natural actions of the stomach.
When gastric juice and liquid albumen were mixed together, they
were so much alike in their appearance at first, that no change was
perceptible; but in ten or fifteen minutes, small, white flocculi began
to appear, floating about, and the mixture became of an opaque whitish
appearance. This appearance continued slowly and uniformly to
increase for three hours, at which time the fluid had become of a
milky appearance; the small flocculi had mostly disappeared, and a
little light coloured sediment subsided to the bottom. No results
are given of the action of the gastric fluid upon coagulated al-
bumen.
Eight ounces of calPs-footje/Zi/ alone were swallowed at 1 o'clock,
P.M. The stomach being examined in twenty minutes, its contents
were found to consist of gastric juice combined with the jelly, nearly
all of which was in a fluid state; a few particles only of entire jelly
were suspended in the fluid, with a few small, yellowish coagula
floating near the surface. At 2 o'clock no appearance of jelly could
be discovered. In another experiment, four ounces of pure gelatine,
(ichthyocolla,) prepared with boiling water, were swallowed at forty-
five minutes past eight o'clock, A. M. At the end of fifteen minutes
the stomach appeared to be nearly as full as after an ordinary meal:
it contained a clear fluid of the consistence of the white of an egg,
composed apparently of the gelatine dissolved or diffused in the gas-
tric juice. The two could not, however, be distinguished from each
other. After the lapse of forty-five minutes the stomach was found
to be nearly empty, all that could be obtained from it being two
drachms of a fluid, which appeared to be a mixture of gelatinous
chyme, gastric juice, and mucous flocculi, more opaque and ropy
than the gastric juice alone, and more acid than were the fluids of
the stomach immediately before the gelatine was swallowed.
Thirty grains of new cheese, masticated, were put in three drachms
of gastric juice, and kept in the axilla for eight hours and thirty mi-
nutes, when the vessel was found to contain a rich milky fluid, on
which floated five grains of a matter consisting principally of oil com-
bined with a soft caseous substance. The fluid had a strong acid, or
Besiumont on Digestiotu 129
peculiar acrid taste, and emitted a strong caseous smell, even stronger
than the cheese itself, before the experiment.
; Bone after being dissolved in the gastric juice, formed a grayish,
vi^hite, opaque fluid, nearly of the colour and consistence of clear,
thin gruel, with considerable fine brown sediment after standing at
rest a while. It had a peculiar insipid, sweetish taste and smell,
without the least fcetor or rancidity.
The solvent powers of the gastric fluid being established, an im-
portant inquiry next presents itself; upon what, namely, do those
powers depend? In other words, does the gastric juice act upon the
food by virtue of certain specific properties which distinguish it from
all other chemical agents, or are its solvent powers to be attributed
-solely to the acids and salts which it contains? The first of these
propositions is assumed by Dr. B.
" The action of the stomach and its fluids on aliment is believed," he remarks,
"to be sui generis, invariably the same on health in all kinds.
" Chyme is a compound of gastric juice and aliment. It may be regarded as
a gastriie of whatever it is combined with, varied according to the kind of ali-
ment used.
"Like all other chemical agents, the gastric juice decomposes or dissolves,
and combines with a fixed and definite quantity of matter when its action
ceases."
Without stopping to comment upon the absurd and inadmissible
term gastrite, applied to the presumed chemical compound resulting
from the union of definite proportions of gastric juice and the different
alimentary substances, albumen, gelatine, fecula and the like, we
shall merely remark, that the specific and invariable character and
action of the fluid secreted by the stomach are mere assumptions,
which are disproved by the very analysis of the fluid, which shows
it to be a mixture of mucus, water, and various salts and acids, the
nature and chemical action of which are well understood. Not a
single experiment is adduced by the author which would lead us even
to suspect that the gastric juice possesses any solvent or chemical
property other than those which result from the substances which are
known to enter into its composition, or that these do not vary, in
their relative proportions at least, at different times.
If it can be shown that other of the animal fluids, or even water,
with the addition of one or other of the active ingredients contained
in the gastric juice, will cause a solution of alimentary substances,
similar to that produced by the latter, the idea of any specific action
being exerted by it is completely overthrown. As early as 1783, it
was stated by Carminati, that he digested veal with a little salt, in
130 Beaumont on Digestion.
pure water at 100° Fah. and that the veal became partially dissolved.
He employed the decanted liquor in similar experiments, until at
length he procured, as he asserts, a fluid possessed of solvent proper-
ties, similar to those of the gastric juice; and in 1788, Struve and
Maquart made an artificial solvent of a weak solution of ammonia,
which had the same properties, according to their statement, as the
gastric juice. But passing over these experiments, which may be
considered inconclusive, we find that Tiedemann and Gmelin in
1825, found that water slightly impregnated with acetic or hydro-
chloric acid, as well as a weak solution of either the acetate or hydro-
chlorate of ammonia severally dissolved, more or less of nearly all
the animal substances employed as food. Several experiments were
likewise performed by Dr. Beaumont, which prove the solvent action
upon food of diluted acetic and hydrochloric acids. In one of these
experiments, equal portions of beef steak masticated, w^ere immersed
in gastric juice, and in an equal quantity of a mixture of muriatic and
acetic acids, reduced by the addition of water to the flavour of the
gastric fluid as nearly as practicable. Both were kept by means of
a sand bath at the temperature of 100° Fah.| at the end of nine hours
the meat in the gastric juice was all dissolved — that in the acid mix-
ture when filtered, left a residuum weighing nine grains, of a gela-
tinous consistence. The solution in the gastric juice was opaque,
and of a lightish gray colour, and deposited on standing a brown se-
diment. That in the acid mixture was also opaque, but of a reddish
brown colour, and deposited no sediment.
A similar experiment was repeated with pure dry gelatine. At the
end of nine hours the gelatine in the gastric juice was entirely dis-
solved; that in the acid mixture when filtered, left a residuum of
three grains of a gelatinous consistence. The solution in the gastric
juice was opaque, and of a whitish colour, with a little fine brown
sediment; that in the dilute acids was also opaque, but of a reddish
brown colour, and of a thin, mucilaginous consistence, without any
sediment. When an infusion of nut-galls was added to the first, it
produced a rich cream-like fluid, and slowly precipitated a fine com-
pact sediment; when added to the second, the whole formed imme-
diately into a coarse, brown coagulum. After standing a while, a
large, loose, brownish sediment was precipitated, leaving a light co-
loured fluid, which became subsequently as white as milk, while the
sediment became compact, and remained so.
The same experiment with gelatine being repeated, at the end of
five hours and a half the portion in the gastric juice was all dissolved
to a mere mite, that in the acid mixture nearly so, six grains only, of
Beaumont on Digestion. 131
a gelatinous consistence, remaining. The fluid in the first was of a
bluish-white colour; in the second yellowish, or about the colour of
dry gelatine. After remaining two hours and three-quarters longer,
the gelatine in the dilute acid was entirely dissolved, and the fluids of
both were nearly similar. The addition of an infusion of nut-galls
fornied in each loose, light-coloured coagula. In the solution formed
by the gastric juice a compact sediment was thrown down, leaving
an opaque milky fluid. In the solution formed by the acids, the
coagula were not precipitated until after the lapse of forty-eight hours,
forming then a compact mass with distinct particles of undissolved
gelatine mixed with a dirty white-coloured, curd-like substance.
Another experiment was performed with a mixture of hydrochloric
and acetic acids, diluted with water to the flavour of gastric juice^
In this was immersed a portion of broiled steak, cut fine, and the
same amount of steak was immersed in an equal portion of gastric
juice. In six hours and three-quarters, the meat in the latter was
nearly all dissolved; in eight hours longer, that in the acid mixture was
dissolved with the exception of a very small jelly-like mass. The
two liquids now resembled each other very nearly. That from the
gastric juice being opaque and of a lightish-gray colour, with a dark
brown sediment on standing; that from the acid mixture was also
opaque, of a reddish-brown colour, but without sediment. The addi-
tion of an infusion of galls caused in the first a fine reddish-brown
precipitate, leaving an opaque liquor of a similar colour; in the
second, a more copious precipitate, leaving a clearer and thinner9
almost transparent, liquor of a yellowish colour.
It is w^ell known that Montegre, in experiments performed with
the saliva acidulated with vinegar, succeeded in dissolving various ar-
ticles of food into a chymous pulp. Of the correctness of these ex-
periments we have not the least doubt, having seen them repeated in
this city with very similar results to those stated by Montegre, and
having before us the additional testimony of a very late French ex-
perimenter,* wlio has shown that the saliva, as well as the mucus of
the intestines, obtained by opening the abdomen of an animal before
eating, when slightly acidulated and kept at the temperature of the
human body, will convert the food immersed in it for twenty-four or
thirty-six hours into a grayish, perfectly homogeneous paste. That
the intestinal mucus will produce changes in food very analogous to
those resulting from the action of the gastric juice, is attested also
* Benjamin Voisin de la Digestion Considereree en General. Paris, June,
1833.
132 Beaumont on Dig^estion,
by TiEDEMANN and Gmelin as well as by Leuret and Lassaigne.
The following experiment was performed by Dr. Beaumont. Two
equal portions of saliva were acidulated to about the flavour of gas-
tric juice, the one with acetic, the other with muriatic acid, and in
each were immersed two pieces of parsnip and two of carrot, the one
boiled and the other raw, each v/eighing ten grains. The tempera-
ture of the fluids was kept at 100° Fahrenheit. After forty-eight
hours, the parsnip in the saliva with muriatic acid had lost four
grains, the carrot nothing; the parsnip in the saliva with acetic acid
had lost six grains, and the carrot four; they appeared to have been
rather macerated and diffused than dissolved or digested. The two
fluids and their contents were now mixed together, and after twenty-
four hours the whole remaining mass of vegetable matter weighed
twelve grains. The fluid appeared now a little more chymous, and
was rather turbid.
It strikes us as not a little surprising that these experiments with
artificial solvents did not suggest themselves to Dr. B. at a much
earlier period than they were performed, (February, 1833,) and that
when entered upon they were not more frequently repeated with dif-
ferent articles of food and with acid mixtures of various strength.
Incomplete as they are, they, hov/ever, prove that as far as it regards
its solvent properties at least the gastric fluid is not sui generis.
It will not do to say that the product of these artificial solutions
is not identical with that resulting from the action of the gastric juice.
This must be proved by a chemical analysis of the two. But even
if they should be shown in this manner to differ materially, it is to
be recollected that the gastric juice contains chemical agents inde-
pendently of its acids, all of which are doubtless necessary in causing
the solution of the dift'erent kinds of food, or perhaps of its different
nutritive principles.
Having thus examined the observations of our author upon the na-
ture and action of the gastric juice, we shall proceed next to the con-
sideration of the various phenomena connected with the process of
digestion. The opportunities he possessed for the careful study of
these render his remarks in relation to them peculiarly interesting.
It will be proper, however, to notice first the views of Dr. B. in re-
gard to the uses of the saliva.
Excepting as a means of introducing food into the animal stomach,
Dr. Beaumont maintains that mastication and insalivation are to be
considered as " perfectly non-essential to chymification." Neither, he
conceives, would be necessary could the food in any other way be intro-
duced into the stomach in a finely divided state. The chyme produced
BediUmont on Digestion. 133
bj the action of the gastric fluid, out of the body, on food unmixed
with saliva, exhibited, he remarks, the same sensible appearances, and
was affected by reagents (?) in the same way, as that which was form-
ed by food which had been previously masticated, mixed with the
saliva and swallowed. Subsequently, Dr. B. admits that mastica-
tion "is absolutely necessary to healthy digestion," that it is to be
considered "as one of the most important preliminary steps in the
process." Although these different statements amount to a direct
contradiction in language, yet we presume that all that is meant is
that perfect comminution of the food, in whatever way it may be
effected, is essential to its digestion; though we cannot conceive how
the process of mastication can be studied in its effects separately
from those of insalivation, excepting with the facilities possessed by
Dr. B. and of these, so far as we are able to judge from the detail
of its experiments, he does not appear to have availed himself. A
series of comparative observations, showing the difference in the di-
gestibility of substances swallowed after mastication in the usual
manner, and those introduced into the stomach through the opening
in a state of minute division only, would have settled the question;
especially if the composition of the chyme formed in both instances
had been carefully examined. Dr. Beaumont, it is true, asserts, as
we have already remarked, that chyme from food mixed with the sa-
liva and swallowed, and that produced by the action of the gastric
juice without any mixture of saliva, did not differ in appearance, and
was affected similarly by reilgents — the results of these experiments
are not given in detail, and of course we cannot judge of their accu-
racy. In one experiment it was found that the saliva, when added
to aliment out of the body, had the effect of facilitating the putrefac-
tion of the latter. This agrees with the observations of the recent
German and French physiologists, and with those of Montegre. If
we even admit that the only effect of this secretion is to induce in
the food an incipient state of putrefaction, this of itself, according
to our author's own showing, would prove that, so far as it regards
animal food, it has a very considerable agency in facilitating diges-
tion, for "the digestibility of most meats," he remarks, "is improved
hy incipient putrefaction, sufficient to render the muscular fibre
slightly tender."
The important part performed by the saliva in digestion, is proved,
we conceive, by the fact of the large glandular apparatus for its se-
cretion, with which nearly all animals are furnished; by the great
quantity which is poured into the mouth during the process of masti-
cation— far more than would be necessary, if it had no other office, as
No. XXVIL— May, 1834. 12
134 Beaumont on Digestion.
supposed by Dr. B., than to facilitate deglutition by lubricating the
alimentary bolus; and by the additional fact, that in the duodenum
the chyme is invariably mixed with another portion of fluid, identical
almost in its composition with the saliva. No one who has examined
a portion of food after it has been well masticated, and intimately
combined with the fluid furnished by the glands of the mouth, but
must be convinced that a very considerable change has been pro-
duced in it. I have ascertained positively^ remarks Dr. Jackson,*
that the saliva does exert a very energetic operation on the food; se-
parating, by its solvent properties, some of its constituent principles,
and performing a species of digestion. Voisin alsot declares, that
when the food is retained for a long time in the mouth, and intimate-
ly mixed with the saliva, it undergoes an actual change, by which its
original character is no longer distinguishable. " I have seen it," he
tells us, *' converted into a grayish homogeneous pulp, very much like
chyme." This change in the appearance of the aliment does not
merely consist, he adds, in its conversion into a soft mass, by which
it is rendered more easily swallowed — it is something more; the ali-
ment experiences a commencing decomposition. In one experiment
related by this author, when food, well triturated and imbued with
saliva, was introduced into the small intestine of an animal, in two
or three hours its chymification was as complete as if the process had
been effected in the stomach. But Dr. Beaumont is not content with
setting down the saliva as unnecessary to digestion, he has under-
taken to prove further, that it actually impedes the solvent action of
the gastric juice. *' It would seem," he remarks, '* from two or three
of the experiments on artificial digestion, which were instituted for
the purpose of comparison, that the mixture of saliva with the gastric
juice rather retarded its solvent action;" and when mixed in large
amount with the gastric fluid, it renders it foetid in a few days. Were
we to admit the opinion of Dr. B. to be correct, namely, that the mix-
ture of saliva with the solvent fluid of the stomach vitiates the latter,
this would be equivalent to asserting that digestion by the natural
actions of the stomach is less perfect than that performed by filtered
gastric juice on finely comminuted aliment out of the body. For we
are to recollect that when solid food is eaten, it does not enter the
stomach until it is mixed, by the process of mastication, with a large
quantity of saliva, and that under ordinary circumstances a portion
of the latter is always swallowed, and of course mixes with the other
fluids of the digestive organs. But we are persuaded, that whoever
* Principles of Medicine, p. 354. f Opera Citat. pp. 205-302.
Beaumont on Digestion. 135
\^ ill read with attention the experiments of Dr. B., and compare them
with each other, must be convinced from them alone, that so far from
the saliva being '' perfectly non-essential" to digestion, it performs
a very important part in facilitating the process.
We shall proceed now to give a sketch of the very interesting ob-
servations of our author in regard to various particulars connected
with the physiology of the stomach, from the correctness of which
we are happy to say, we shall have but few occasions to dissent.
Dr. Beaumont has proved with great clearness, that the gastric
juice does not accumulate in the stomach in the intervals of digestion,
as many physiologists, and Spallanzani among the number, have
supposed; but is secreted only when food is admitted into the gastric
cavity, or some other stimulus is applied directly to its lining mem-
brane. This fact was pointed out long since by Chaussier, and more
recently by the experiments of Tiedemann and Gmelin, and those of
Leuret and Lassaigne.
When it does not contain food. Dr. B. has usually observed the
stomach to be empty and contracted, the rugae formed by its inner
coats being irregularly folded upon each other, and almost in a qui-
escent state. The whole of the mucous membrane of the stomach
when perfectly free from disease, is of a light or pale pink colour,
of a soft velvet-like appearance, and covered constantly with a very
thin transparent viscid mucus.
" Immediately beneath the mucous coat ( ? ) and apparently incorporated
with the villous membrane, appear small, spheroidal, or oval-shaped, glandular
bodies, from which the mucous fluid appears to be secreted."
If the mucus covering the inner coat of the stomach be wiped oft*
with a sponge during the period of chymification, the mucous mem-
brane appears roughish, and at first, of a deep pink colour, but in a
few seconds the follicles and line papillae begin to pour out their res-
pective fluids, which being diff'used over the parts from which the
mucus had been removed, restore to them their peculiar soft, velvet-
like appearance and pale pink colour, and the gastric juice begins to
trickle down the sides of the stomach. When the mucus is wiped oft'
during the period the stomach is empty, a similar roughness and
deepened colour are produced, though in a less degree. The follicles
appear to swell more gradually, and the fluids are not secreted in
sufficient quantity to trickle down, as during the period of chymifica-
tion.*
* Dr. Beaumont speaks of wiping off the mucous coat or membrane of the
stomach, (page 107,) and of the mucous coat being restored, (ibid.;) these are
136 BediUmont on Digestion.
When the tongue is applied to the mucous coat of the stomach in
the empty, unirritated state of the organ, no acid taste is perceptible,
but whenever food or any other irritant is applied to the membrane
so as to excite the gastric papillae, an acid taste is immediately per-
ceptible.
The ordinary temperature of the interior of the stomach during
health Dr. B. has ascertained to be about 100° Fahr., as well in the
intervals as during the process of digestion. There would appear,
however, to be some difference in the temperature of different regions
of the organ, it being somewhat higher at the pyloric than at the car-
diac extremity. Variations in the state of the atmosphere were found
in some of Dr. B's experiments, to affect the temperature of the sto-
mach; a dry state of the atmosphere increasing, and a humid one di-
minishing it. Active exercise also was found to elevate invariably
the temperature of the stomach, under all circumstances, about one
and a half degrees.
When a portion of food is received into the stomach, the action of
the vessels of its mucous coat become increased, the latter acquires
a brighter red colour, the vermicular motions of the organ are ex-
cited, and the secretion of the gastric juice commences.
The latter appears to issue *' from innumerable vessels, distinct
and separate from the mucous follicles. These vessels, when ex-
amined with a microscope, appear in the shape of small lucid points,
or very fine papillae, situated in the interstices of the follicles." The
gastric fluid, according to the observations of the author, is secreted
in quantities exactly proportioned to the amount, and greater or less
degree of solubility of the food admitted into the stomach, excepting
when more is eaten than is necessary for the wants of the system.
The fluid is either absorbed by the portion of aliment in contact with
the coats of the organ, or collects in small drops, and trickles down
the sides of the stomach, to the more depending parts, and there
mingles with the food or whatever else the stomach contains.
" In febrile diathesis, or predisposition from whatever cause — obstructed per-
spiration, undue excitement by stimulating- liquors, overloading- the stomach
certainly only loose modes of expression; he cannot possibly have confounded
the mucous tissue of the stomach with the mucus by which it is covered; and
yet we might infer this from his language, especially when he speaks con-
stantly of a villous coat independently of the mucous coat. We have marked
in numerous parts of the work expressions in the highest degree inaccurate:
thus, he speaks of *' nervous or vascular papillae" secreting the gastric juice,
(pp. 103-4,) of glands constituting a part of " the erectile tissue of the sto-
mach," (p. 58,) and of the " excretory ducts of the gastric vessels," (p. .104.)
'Beaumont on Digestion, 137
with food— ^fear, anger, or whatever depresses or disturbs the nervous system,
the villous coat becomes sometimes red and dry, at other times pale and moist,
and loses its smooth and healthy appearance — the secretions become vitiated,
greatly diminished, or entirely suppressed — the mucous coat ( ? ) scarcely per-
ceptible, the follicles flat and flaccid, with secretions insufficient to protect the
vascular and nervous papillse from irritation.
" There are sometimes found on the internal coat of the stomach, eruptions,
or deep red pimples, not numerous, but distributed here and there upon the
villous membrane, rising above the surface of the mucous coat. ( ? ) These are
at first sharp-pointed and red, but frequently become filled with white purulent
matter. At other times irregular circumscribed, red patches, varying in size
or extent from half an inch to an inch and a half in circumference, are found on
the internal coat. These appear to be the effect of congestion in the minute
blood-vessels of the stomach. There are also seen at times, small aphthous
crusts in connection with these red patches. Abrasions of the lining membrane,
like the rolling up of the mucous coat ( ? ) into small shreds or strings, leaving
the papillae bare, for an indefinite space, is not an uncommon appearance.
" These diseased appearances, when very slight, do not always affect es-
sentially the gastric apparatus ( ?) when considerable, and particularly when
there are corresponding symptoms of disease, as dryness of the mouth, thirst,
accelerated pulse, &c. no gastric juice can be extracted, not even on the ap-
plication of alimentary stimulus. Drinks received, are immediately absorbed,
or otherwise disposed of; none remaining in the stomach ten minutes after being
swallowed. Food taken in this condition of the stomach, remains undigested
for twenty-four or forty-eight hours, or more, increasing the derangement of
the whole alimentary canal, and aggravating the general symptoms of disease."
Dr. B. has observed that when a portion of food is received into
the stomach, the rugae of the latter gently close upon it, and, if suffi-
ciently fluid, gradually diffuse it through the cavity of the organ, en-
tirely excluding more during this action. The contraction ceasing,
another quantity of food will be received in the same manner. It
was found that v/hen the valvular portion of the stomach in the sub-
ject of his experiments was depressed, and solid food introduced,
either in entire pieces or finely divided, the same gentle contraction
or grasping motion took place, and continued for fifty or eighty
seconds, and would not allow of the introduction of another quantity
until that period had elapsed, when the valvx3 could be again depress-
ed and more food put in. When the subject was so placed that the
cardia could be seen, and then allowed to swallow a mouthful of food,
the same contraction of the stomach and grasping of the bolus was
invariably observed to commence at the oesophageal ring. Hence,
when food is swallowed too rapidly, irregular contractions of the mus-
cular fibres of the oesophagus and stomach are produced, the vermi-
cular motions of the rug^ are disturbed, and the regular process qf
.digestion is interrupted.
138 Beaumont on Digestion.
Contrary to the opinions of many physiologists., Dr. B. has ascer-
tained that the solution of the food commences immediately after it
is received into the stomach. Water, alcohol, and other fluids not
containing alimentary matter in solution, pass from the stomach very
soon after they are received, either by absorption or through the py-
lorus. Liquid albumen and albuminous fluids are first coagulated,
and then dissolved by the gastric juice. Food taken in a liquid form
combined with a large quantity of water, as soup, &c. is deprived by
absorption of its aqueous portion before its digestion is commenced.
According to Dr. Wilson Philip, and the fact is confirmed by the ex-
periments of Brodie, Broughton, Breschet, Edwards, and others, the di-
gestion of the food commences first in the portion immediately in contact
with the surface of the stomach, and as the thin layer of chyme there
formed is removed by the muscular action of the organ, a second layer
is chymified — digestion always commencing on the surface of the food.
In reference to this opinion, Dr. Beaumont remarks: —
" That chymification commences on the surface of the food I have no doubt;
but I apprehend this to be the case as it respects each individual portion, and
not the whole mass.
"When a due and moderate supply of food has been received, it is probable
that the vi^hole quantity of gastric juice for its complete solution, is secreted,
and mixed v^ith it in a short time. If a tenacious mass of food be used, the
external portion of the whole quantity is first acted on, digested, and suc-
ceeding- portions presented, he. From numerous examinations of the sto-
mach, I feel warranted in saying, at least in the human subject, that there is a
perfect admixture of gastric juice and food — that tlie particles of food are con-
stantly changing their relations with each other."
We would inquire, however, of Dr. Beaumont, whether he has
ascertained positively that contact of the food with the coats of the
stomach is not essential to its perfect digestion? The whole mass of
food contained in the stomach may be pervaded by the gastric juice
and solution go on equally in every part of it, but the question is,
does a single particle become converted into perfect chyme that has
not come in contact with the parietes of the digestive organ, so as to
enable the absorbents of the latter to act upon it? From a careful
consideration of all the phenomena of digestion, we feel no hesita-
tion in asserting as our opinion, that chymification, strictly speaking,
invariably takes place in that portion of the aliment which is applied
to the inner surface of the stomach, and that it can take place no
where else. It will not do for Dr. B. to reply that he has produced
chyme by the action of the gastric juice on aliment out of the sto-
mach, he must first show by a chemical analysis that the fully form-
ed chyme as it passes into the duodenum, and the food after its solu-
Beaumont on Digestion. 139
tion, merely, bj the gastric juice, are identically the same — and this
he has not even attempted to do. That the absorbents of the stomach
do act upon the aliment is proved by the fact, that a chylous fluid
is formed by these vessels as well as by those of the intestines. This
is shown by the experiments of Leuret and Lassaigne, and more re-
cently by those of Yoisinc
Dr. Beaumont having observed a large proportion of fluid in the
stomach, even after a dry and solid meal had been eaten, presumes
that a synthetic formation of water from its elements takes place in
that organ. We need only remark that the supposition is in the
highest degree improbable; whatever amount of fluid may be poured
into the stomach during digestion, we have no right to refer it to any
other source than the exhalants of the mucous membrane.
The stomach is not quiescent during the process of chymification.
By the alternate contraction and relaxation of its transverse muscu-
lar fibres a peristaltic motion is produced, which commences soon
after the food is received, and causes the latter to revolve around the
interior of the gastric cavity, from point to point and from one ex-
tremity to another.
" The ordinary course and direction of the revolutions of the food," accord-
ing- to our author's observations, *'are first, aftdr passing- the oesophageal ring",
from rig-ht to left, along- the small arch; thence, through the large curvature,
from left to right. The bolus as it enters the cardia turns to the left, descends
into the splenic extremity, and follows the great curvature towards the pyloric
end. It then returns, in the course of the smaller curvature, to perform simi-
lar revolutions."
These revolutions are completed in from one to three minutes.
They are, however, slower at first than after chymification has con-
siderably advanced.
The motions of the stomach not only produce the revolutions of
the food just referred to, but, by a kind of agitation or churning of
the contents of the organ, cause the particles of the aliment to be
separated from each other and intimately mixed with the gastric
fluids.
*' There is nothing," remarks Dr. B. "of the distinct lines of separation be-
tween the old and new food, and a peculiar central or peripheral situation of
crude as distinguished from chymified ahment, said to have been observed by
Philip, Magendie, and others in their experiments on dogs and rabbits, to be
seen in the human stomach; at least in that of the subject of these experiments^
The whole contents of the stomach, until chymification be nearly complete,
exhibit a heterogeneous mass of solids and fluids; hard and soft, coarse and
fine, crude and chymified; all intimately mixed, and circulating- promiscuously
through the gastric cavity, like the mixed contents of a closed vessel, g-ently
agitated or turned in the hand."
140 Beaumont on Digestion.
We suspect, however, that this commixture of the different con-
tents of the stomach, noticed in the experiments of our author, must,
in some measure, have been owing to the manner in which he extract-
ed them for examination; namely, **by depressing the valve within
the aperture, shaking a little, and pressing upwards." The firm com-
pression which the stomach exerts upon its contents, would, of itself,
be sufficient to force the more fluid portions to the surface, and un-
less some such separation does take place we cannot conceive how
the digested food is carried off, bj the muscular actions of the sto-
mach, through the pylorus, while that which has not undergone the
process of chymification is retained. On two occasions Dr. B. would
seem to admit, that the digested and undigested portions of the ali-
ment occupy different portions of the gastric cavity. Thus, at page
142:—
"It is possible," he remarks, "that the portion, (of aliment) presented at
the perforation, may be in a more advanced stage of digestion than the rest of
the mass, and consequently lighter, and float on the surface of the more sohd
portions of the food. In ordinary cases such would be found to be the case."
And again, at page 144: —
*' It may be inferred from this experiment, (the 26th,) that the more per-
fectly chymified portions of food rise to the superior part of the stomach, as
suggested in a preceding observation, and are consequently exposed at the per-
foration, from whence parcels are taken for experiment and examination."
According to Dr. Wilson Philip's observations, when food has been
taken at different times, the new is never mixed with the old. Dr.
Beaumont, however, conceives that this statement is not correct, but
that in a very short time the food already in the stomach and that
subsequently eaten become combined.
" One thin^," he remarks, " is certain, and it is capable of demonstration in
the stomach of the subject of these experiments, that old and new food, if they
are in the same state of comminution, are readily and speedily mixed in the
stomach."
The ordinary time required for the complete digestion of the food
received into the stomach, during a healthy state of the organ. Dr.
B. has ascertained to be about three hours and a half. The facility of
digestion is modified, however, by many circumstances, as idiosyn-
crasies, habit, the nature of the food and the manner in which it is
prepared. Minuteness of division of the aliment and tenderness of
its fibre, would appear to be the two great essentials for its speedy
and easy digestion.
" Albumen, if taken into the stomach, either very slightly or not at all co-
.agulatcd, is periiaps asTapidly chymified as any article of diet we possess. If
Beaumont on Digestion. 141
perfectly formed into hard coag-ula by lieat or otherwise, and swallowed in large
solid pieces, it experiences a very protracted digestion. Fibrine and gelatine
are affected in the same way. If tender and finely divided, they are disposed of
readily? if in large and solid masses, digestion is proportionably retarded."
Animal fat is very quickly and invariably rendered fluid bj the
heat of the stomach, and, together with every species of oily food, re-
sists for a long time the action of the digestive organ and its fluids.
Dr. B. has observed that when the use of fiit or oily food has been
persevered in for a long time, there very generally takes place an
admixture of bile with the gastric fluids, and from numerous experi-
ments he has been led to believe that this admixture of bile has the
effect of facilitating the solution of such kinds of aliment.
"Bulk is, perhaps, nearly as necessary to the articles of diet as the nutrient
principle. They should be so managed that one should be in proportion to the
other. Too highly nutritive diet is probably as fatal to the prolongation of life
and health, as that which contains an insufficient quantity of nutriment."
Solid aliment Dr. B. has observed to be sooner disposed of by the
stomach than fluid; he conceives, also, that its nutritive principles
are sooner carried into the circulation. The correctness of the latter
proposition is however very doubtful; the very fact, admitted by the
author, that exhaustion from abstinence, namely, is more quickly re-
moved by liquid than by solid food, would certainly seem to dis-
prove it.
An incipient state of putrefaction, sufficient to render the muscu-
lar fibre slightly tender, was found to increase the digestibility of
most kinds of flesh.
Vegetable aliment, generally speaking, he discovered to be slower
and more diflicult of digestion than animal. Its solution in the sto-
mach is greatly influenced, however, by division and tenderness of
fibre. Crude vegetables often pass through the pylorus in an undi-
gested state, while other food is retained and fully digested.
The thorough mastication of the food is essential to healthy di-
gestion.
"If aliment," remarks the author, '"^in large masses be introduced into the
stomach, though the gastric juice may act upon its surface, chymification will
proceed so slowly, that other changes will be likely to commence in its sub-
stance before it will become completely dissolved. Besides, the stomach will
not retain undigested masses for a long time without suffering great dis-
turbance."
Consequently, eating too fast impedes digestion, by introducing
food into the stomach in a state unprepared for the actions of that or-
gan and of its fluids. If food, also, be swallowed too rapidly more
142 Beaumont on Digesiion.
will in general be taken into the stomach, before the sense of liunger
is allayed, than can be digested with ease.
Overloading the stomach with aliment was invariably found to in-
terfere with the regular process of chymificationj a portion remaining
for a long time undigested. This very soon becomes rancid or runs
into acetous fermentation, and if not rejected by vomiting, causes
pain and irritation of the stomach and other distressing symptoms; or
it is permitted to pass into the intestines, where its presence almos-t
invariably gives rise to colic, flatulence, or even more dangerous af-
fections.
The reason why too large an amount of food is injurious, is sup-
posed by our author to be, because " the quantity of gastric juice,
either contained in its proper vessels, or in a state of preparation in
the circulating fluids, is believed to be m exact proportion to the pro-
per quantity of aliment required for the due supply of the system."
Hence, if more food than is necessary be taken, a part of it must con-
sequently remain undigested. We have no evidence, however, that
the solvent fluid secreted by the stomach is furnished only in a cer-
tain amount; it appears to us more probable, that when too large a
quantity of food is eaten, it causes an undue distention of the sta-
mach, and in this manner prevents its regular and healthy actions
from going on: while, at the same time, most generally the food is
swallowed faster than the gastric juice is secreted, and in a state un-
fitted to be acted upon by it.
Condiments, according to our author, though they may at first ex-
cite the action of a debilitated stomach, yet when used habitually,
never fail to produce indirect debility of that organ, and in this man-
ner impede digestion.
** Salt and vinegar are exceptions, and are not obnoxious to this charge when
used in moderation. They both assist digestion — vinegar, by rendering mus-
cular fibre more tender — and both, by producing a fluid having some anabgy to
the gastric juici^"
Alcoholic, and Dr. B. thinks probably all artificial drinks, impede
more or less the digestive process; some more so than others; " but
none can claim exemption from the general charge. Even coffee and
tea, the common beverages of all classes of people, have a tendency
to debilitate the digestive organs." In the correctness of these opi-
nions we most heartily and fully concur.
Our author has found, from numerous trials, that moderate exer-
cise, so far from interrupting digestion, conduces greatly to its
healthy and rapid performance. Severe and fatiguing exercise, how-
ever, always retards digestion.
Beaumont on Digestion. 143
It is stated by most physiologists, that during digestion the sto-
mach becomes a centre of fluxion; but against the use of such an ex-
pression Dr. Beaumont strongly objects; it being one, as he declares,
to which no definite meaning can be attached. We confess that we
were somewhat surprised at this assertion; we have repeatedly em-
ployed the same expression ourselves, and really did believe that we
were conveying to all our readers who were any way conversant with
medical language a definite idea; namely, that more blood is deter-
mined to the stomach during the period of digestion than when the
functions of that organ are not in exercise. That the stomach really
does become a centre of fluxion when digestion is going on, is proved
by the observations which Dr. B. has himself recorded. He tells us,
that, during digestion, the action of the vessels of the mucous mem-
brane is increased, that the colour of the latter is of a brighter red, and
that a very copious secretion takes place from its follicles and pa-
pillae— that all this is occasioned by an irritation of the membrane re-
sulting from the presence of the food; and further, that gentle exer-
cises increases the circulation in the vessels of the stomach and the
temperature of the latter, and in this manner facilitates digestion.
♦' As the food becomes more and more changed from its crude to its chymified
state, the acidity of the gastric fluids is considerably increased; more so in ve-
getable than in animal diet; and the general contractile force of the muscles of
the stomach is augmented in every direction; giving the contained fluids an im-
pulse towards the pylorus.
** It is probable that from the very commencement of chymification— from the
time that food is received into the stomach, until that organ becomes empty,
portions of chyme are constantly passing into the duodenum, through the py-
loric orifice, as the mass is presented at each successive revolution. I infer this
from the fact, that the volume is constantly decreasing. This decrease of
volume, however, is slow at first; but is rapidly accelerated towards the con-
clusion of digestion, when the whole mass becomes more or less chymified.
This accelerated expulsion appears to be affected by a peculiar action of the
transverse muscles, or rather of the transverse band, as described by Spallanzani,
Haller, Cooper, Sir E. Home, and others, in their experiments on animals.
This band is situated near the commencement of the more conical shaped part
of the pyloric extremity, three or four inches from the smaller end. In attempt-
ing to pass a long glass thermometer tube through the aperture, into the pyloric
portion of the stomach, during the latter stages of digestion, a forcible contrac-
tion is first perceived at this point, and the bulb is stopped. In a short time
there is a gentle relaxation, when the bulb passes without difficulty, and ap-
pears to be drawn forcibly, for three or four inches, towards the pyloric end.
It is then released, and forced back, or suflTered to rise again; at the same time
giving to the tube a circular, or rather spiral motion, and frequently revolving
it completely over. These motions are distinctly indicated, and strongly felt,
in holding the end of the tube between the thumb and finger; and it requires a
144 Beaumont on Digestion.
pretty forcible grasp to prevent it from slipping* from the hand, and being drawn
suddenly down to the pyloric extremity. When the tube is left to its own di-
rection, at these periods of contraction, it is drawn in nearly its whole length,
to the depth often inches; and when drawn back, requires considerable force,
and gives to the fingers the sensation of a strong* suction power, like drawing
the piston from an exhausted tube. This ceases as soon as the relaxation oc-
curs, and the tube rises again of its own accord three or four inches, when the
bulb seems to be obstructed from rising further; but if pulled up an inch or two
through the stricture, it moves freely in all directions in the cardiac portions,
and mostly inclines to the splenic extremity, though not disposed to make its
exit at the aperture. Above the contracting band, and towards the splenic portion
of the stomach, the suction or grasping motion is not perceptible; but when the
bulb is pushed down to this point, It is distinctly felt to be grasped, and con-
fined in its movements. These peculiar motions and contractions continue until
the stomach is perfectly empty, and not a particle of food or chyme remains,
when all becomes quiescent again.
*' If the bulb of the thermometer be suffered to be drawn down to the pyloric
extremity, and detained there for a short time, or if the experiment be too fre-
quently repeated, it causes severe distress, and a sensation like cramp or spasm,
which ceases on withdrawing the tube, but leaves a sense of soreness and ten-
derness at the pit of the stomach.
** These peculiar contractions and relaxations succeed each other at irregular
intervals, of from two to four or five minutes. Simultaneously with the con-
tractions, there is a general shortening of the fibres of the stomach. This organ
contracts upon itself in every direction, and its contents are compressed with
great force. During the intervals of relaxation, the rugae perform their vermi-
cular motions, and the undulatory motions of the fluids continue.
From the foregoing facts, Dr. B. draws the following conclusions,
namely, that —
** The longitudinal muscles of the whole stomach, with the assistance of the
transverse ones of the splenic and central portions, carry the contents into the
pyloric extremity. The circular or transverse muscles contract progressively
from left to right. When the impulse arrives at the transverse band, this is ex-
cited to a more forcible contraction, and closing upon the alimentary matter
and fluids contained in the pyloric end, prevents their regurgitation. The
muscles of the pyloric end now contracting upon the contents deposited there,
separate and expel some portion of the chyme. After the contractile impulse is
carried to the pyloric extremity, the circular band and all the transverse muscles
become relaxed, and a contraction commences in a reversed direction from right
to left, and carries the remaining contents again to the splenic extremity, to un-
dergo similar revolutions."
"After the expulsion of the last particles of chyme, the stomach becomes
quiescent, and no more (gastric) juice is secreted, until a fresh supply of food
is presented for its action, or some other mechanical irritation is applied to the
internal coat (of the orgai.)"
We have inserted the preceding quotations, notwithstanding their
Beaumont on Digestion. 145
length, in consequence of the highly interesting view which they pre-
sent of the muscular actions of the stomach during digestion. The
opportunity which the author enjoyed for studying them with care,
precludes any doubt as to the correctness of his observations.
We come next to the consideration of a very important question 5
what, namely, are the changes produced in the food by the process
of chymification? That solid food is dissolved in the stomach, we
have now most abundant proof, and that most kinds of aliment un-
dergo other and still more important changes, we have very strong
reasons for presuming. But whether these changes consist merely in
the breaking up of the union which existed between the proximate
principles of the food, in the separation of such as are adapted for the
formation of chyle from the recrementitious particles, or in an actual
alteration in its chemical composition, are questions which still re-
main undecided. Not the least information in relation to them
can be gleaned from the experiments and observations under re-
view.
Chyme, or the product of stomachic digestion, is generally de-
scribed to be a homogeneous, grayish paste, of a slightly acid tastej
its acidity was found by Tiedemann and Gmelin to be greatest when
the food is the most difficult of digestion. According to the observa-
tions of Dr. B. in its homogeneous appearance the chyme is invaria-
ble, but not in its colour, this being affected in a slight degree by
the kind of food from which it is produced.
** It is always," he remarks, " of a lightish or grayish colour, varying in its
shades and appearance from that of cream to a grayish or dark-coloured gruel.
It is also more consistent at one time than at another? modified in this respect
by the kind of diet used. This circumstance, however, does not affect its ho-
mogeneous character. A rich and consistent quantity is all alike, and of the
same quality. A poorer and thinner portion is equally uniform in its appearance.
Chyme from butter, fat meats, oil, &c. resembles rich cream. That from farina-
ceous and vegetable diet has more the appearance of gruel. — It is invariably
distinctly acid, and possesses properties different from the elements of which
it is composed."
A series of microscopic examinations of the chyme are furnished
by the author; they lead, however, to no satisfactory conclusions in
regard to its real character and composition.
It will, no doubt, be anxiously inquired, whether, by the experi»
ments and observations of Dr. Beaumont, all the agents concerned
in the process of digestion have been determined .^ To this inquiry,
the reply must be in the negative. Excepting so far as relates to the
No. XXVII.— May, 1834. 13
146 Beaumont on Digestion.
solvent powers merely of the gastric juice, they leave every thing in
relation to the efficient cause of digestion in the same doubt and ob-
scurity in which it was previously involved. Dr. B. it is true, infers
from the result of his experiments, that the gastric fluid is the sole
agent by which the food is converted into chyme; but until he shall
be able to prove that fully-formed chyme, in the state in which it
passes into the duodenum, and the fluid mass which results from the
action of the gastric juice alone upon the food, are in all respects
identically the same, and that the absorbents of the stomach do not
act upon the dissolved aliment presented to their orifices, we must
be permitted to consider his opinion in regard to the uses of the gas-
tric juice as a mere hypothesis, the facts in support of which are still
to be made out. Even the proposition with which the work before us
closes, namely, "that no other fluid produces the same eflfect on food
that gastric juice does, and that it is the only solvent of aliment^^^ he
is very far from having established. Tiedemann and Gmelin, as well
as Leuret and Lassaigne, maintain, as the result of their experiments,
that the mucus of the intestines possesses equally with the gastric juice
the power of dissolving the food and converting it into a substance simi-
lar to chyme, and the fact is supported by the later observations of
Voisin. The latter gentleman relates a number of experiments which
prove that the gastric juice is not essential to the perfect digestion of
alimentary substances. Of these experiments we present the follow-
ing summary: — 1st. Food triturated and mixed with saliva, when in-
troduced into the small intestines of an animal, was in two or three
hours as completely chymified as though the process had been per-
formed in the stomach. 2d. Food of a moderate consistence, with-
out any preparation, introduced into the upper portion of the small
intestine of an animal, the communication between the intestine and
stomach being cut off by the passage of a ligature, became perfectly
chymified. Chyle as well as faeces were also formed. A dog was
nourished in this manner for a month, and then killed. 3d. Food
introduced into the coecum, the ileo-coecal valve being closed by a
ligature, was, at the end of four hours, found to be sensibly changed,
and presented some of the characters of chyme.
The fact is, the absorbents of the stomach and alimentary canal
generally, perform a much more important part in the process of di-
gestion than is commonly supposed. Doubtless the saliva, the gastric
fluids, and even the bile and pancreatic juice, all, under ordinary
circumstances, facilitate in a very great degree the conversion of the
food into chyme and the formation of chyle; but to no one nor to all
Beaumont on Digestion. 147
of them are we inclined to ascribe any further agency in the process
of digestion.
A number of experiments were performed by Dr. B. to ascertain,
if practicable, the effects produced by the bile and pancreatic juice,
when added to chyme. These experiments are acknowledged by the
author to be very imperfect, and to lead to no positive conclusions.
In the general summary, nevertheless, of the inferences which he
conceives to be deducible from his experiments and observations is
the following, namely, *'that chyme is formed in the duodenum and
small intestines, by the action of bile and pancreatic juice on the
chyme." It is hardly necessary for us to enter into a refutation of
this assertion. No physiologist, so far as we are aware, states that
he has ever seen chyle in any part of the cavity of the intestines,
while many, after performing numerous experiments to determine the
fact, have declared that chyle never exists out of the lacteals, a con-
clusion which is now almost universally adopted. That the bile and
pancreatic juice, particularly the former, are not by any means essen-
tial to the formation of chyle is conclusively established by the facts
adduced by the German and French experimenters so frequently
alluded to in this review, and which, likewise, very clearly point out
the manner in which Brodie and Mayo were led into the erroneous
conclusion that when the choledochus duct is tied in animals no trace
of chyle can be detected in the lacteals. The recent experiments of
Voisin prove, also, that chyle is formed notwithstanding the oblitera-
tion of the common duct of the liver and gall-bladder. With these
remarks, we take our leave of this portion of Dr. Beaumont's work.
Before concluding, we have a remark or two to make in reference
to our author's explanation of the cause of hunger. Dr. B. main-
tains, that the quantity of gastric juice necessary for the solution of
just so much food as is required for the due support of the system is
prepared during the intervals of digestion, and, just before a meal, fills
and distends its proper vessels, ready to be poured into the stomach the
moment food is swallowed; and that the sensation of hunger is pro-
duced by this distention or repletion of the secernent vessels of the
stomach by the gastric fluid.
We might reply to this hypothesis by asking the author for the evi-
dence by which the correctness of his premises is established. Is
it established satisfactorily, that the gastric juice is secreted previ-
ously to the stimulus of food being applied to the coats of the sto-
mach, and only in a certain definite amount? Or can it be proved
that a distention of the "gastric vessels," as Dr. B. terms them^
148 Beaumont on Digestion.
does really exist whenever the sensation of hunger is experienced,
and that the intensity of the latter is in exact proportion to the degree
in which these vessels are loaded with the solvent fluid? We shall
certainly be excused if we refuse our assent to the author's explana-
tion of the cause of hunger, until the above points are clearly made
out. But in the absence of any fact which bears directly upon them,
we conceive that from the author's own experiments the incorrect-
ness of his views in this particular may be shown. 1st. If there is
in fact an exact relation between the quantity of the gastric juice in
its proper vessels, and the quantity of aliment demanded by the
wants of the system, how is it possible that the subject of our au-
thor's experiments could take into his stomach a full meal, a very
short time after Dr. B. had drawn off one or two ounces of the juice,
and yet digestion be regularly and promptly performed without being
in the least affected by the loss of so considerable a portion of the
proper solvent fluid. 2dly. If hunger depend upon the distention of
certain vessels of the stomach by the gastric juice, how comes it that
an hour or two before the least sensation of hunger was experienced,
the author was able to draw off a large amount of gastric juice
from the stomach, without the appetite of the patient being prevent-
ed from occurring at his regular meal-time, while in other instances,
immediately preceding a meal a very small quantity of the juice was
with difficulty procured, and yet the usual amount of food being
taken immediately afterwards, its digestion was effected without the
slightest unusual delay or difficulty. Sdly. How does the author's
theory of the cause of hunger comport with the following fact. In
experiment 64, page 207; three drachms of gastric juice were ex-
tracted from the stomach, and in fifteen minutes afterwards the
young man ate four ounces of pure gelatine prepared with boiling
water, which was almost entirely digested at the end of an hour,
when a breakfast of pork and bread was taken with the usual degree
of appetite. Thus, notwithstanding the unloading of the distended
vessels by the extraction of three drachms of gastric juice, and by
that which was poured into the stomach to dissolve four ounces of
gelatine, it appears that the ordinary natural appetite of the subject
was in no degree destroyed.
In many persons appetite for food is destroyed by allowing the
usual period of a meal to pass by without eating, and in most indivi-
duals it is almost instantly dissipated, and even the food already
taken prevented from being digested, by sudden emotions of the mind,
disgust and other sensations. These facts, it is true, may be explain-
Beaumont on Digestion. 14
ed in conformity with the views advanced by our author, by supposing
an immediate absorption, in such instances, of the gastric juice dis-
tending the vessels, and a suspension for a time of its further secre-
tion; but we have no evidence either that distention of the gastric
vessels or absorption of the gastric juice contained in them takes
place. If we were to presume that distention of the gastric vessels pro-
duces the sensation of hunger, and that when aliment is not taken
into the stomach at regular periods the gastric juice is absorbed, pro-
longed abstinence, whatever effects it may produce upon the system,
should never give rise to that craving for food, that extreme hunger,
which we know is the most tormenting phenomenon by which it is at-
tended.
There are many other points embraced in the work before us which
we should like to have noticed, had our limits permitted, but we must
now draw our remarks rapidly to a close.
We have presented, so far as we were able in the space allotted to
this review, a clear, and we trust satisfactory, view of the labours
and opinions of the author. We have acknowledged the importance
of the facts established by his experiments and observations, and
given him credit for the perfect candour with which his opinions have
been formed; we have taken the liberty, however, to dissent from the
latter whenever we believed them to be unsupported by sufficient
evidence, or in opposition to the facts already in our possession.
The experiments and observations of Dr. Beaumont cannot fail to
be favourably received by the members of the profession, as afford-
ing, in very many particulars, a valuable addition to their knowledge
of the physiology of certainly one of the most important organs of
the animal system, and as a means of facilitating the inquiries of fu-
ture experimenters into the true nature and cause of chymification.
In the event of a second edition, which will no doubt be speedily
called for, a careful revision of his text will enable the author to re=
move those inaccuracies and obscurities of style v/ith which the pre-
pent is replete. D. F. C,
150 Edwards on the Influence of Physical *Bgents on Life,
Art. XIV. On the Influence of Physical Agents on Life. By W. F.
Edwards, M. D., F. R. S., Member of the Royal Academy of
Sciences, and Royal Academy of Medicine of Paris, of the Philo-
mathic Society of the same city, and of the Medical Society of
Dublin, &c. Translated from the French, by Dr. Hodgkin and
Dr. Fisher. To which are added, in the Appendix, Some Observa-
tions on Electricity^ by Dr. Edwards, M. Pouillet, and Luke
Howard, F. R. S.; On Absorption, and the Uses of the Spleen, by
Dr. Hodgkinj On the Microscopic Characters of the Animal Tis-
sues and Fluids, by J. J. Lister, F. R. S. and Dr. Hodgkin; and
Some Notes to the work of Dr. Edwards. London, 1832. 8vo.
pp. 488.
A HE original of the valuable work before us was given to the world
many years ago, but being composed in a foreign tongue, the import-
ant experiments and deductions which it contains were communi-
cated but partially through the journals of the period, and as every
page teems with useful and interesting information a small portion
only of its contents could be laid before the profession in that way.
Drs. Hodgkin and Fisher have consequently rendered a real ser-
vice to the profession, by the publication of an English version.
Many of the chapters were read at different times to the Academy of
Sciences of Paris, and obtained for Dr. Edwards, who is an English-
man by birth, but was educated in Paris, and has resided there for
the greater part of his life, the honourable distinction of the physio-
logical prize.
"It is certainly to be regretted," says Dr. Hodgkin, " that our philosophical
countryman has not himself exhibited his Instructive work In an English dress,
that our medical hterature might have the credit of possessing it as an original
rather than as a translation. Translations are generally inferior to original pub-
lications. In the present Instance I have endeavoured to reduce the weight of
this objection by submitting the translation to the author's perusal, and he has
kindly supplied me with some fresh matter, which will be found in the Appen-
dix. Whilst I feel justified in expressing myself as I have done with respect to
the original work, to which I have to acknowledge the obligation of much im-
portant assistance in practice, I must confess myself very differently circum-
stanced with regard to the translation.
" To suit the convenience of English students, who have in general neither
time nor inclination for voluminous reading, Dr. Fisher and myself have labour-
ed, as far as possible, to compress the work without omitting a single experi-
ment or conclusion. This, however, has been no easy task, as Dr. Edwards's
own method of exposing the subjects of which he treats is in general too con-
Edwards on the Influence of Physical *^gents on Life. 151
cise to admit of abbreviation, without incurring the risk of producing obscu-
rity." Preface, p. vi.
As it is not probable that the work will be republished in this
country, we shall endeavour to lay before the reader such an analysis
as may serve as a useful succedaneum; although it is impossible, in
the .space to which we must necessarily be confined, to embrace
every important topic, and to elucidate it in the happy manner of the
author. They, however, who seek for further information, will have
to provide themselves with the work itself, which will amply repay
them for the trifling outlay.
The work is divided into four parts, according to the animals ex-
perimented on: — 1. Batrachian reptiles. 2. Fishes and reptiles. 3.
Warm-blooded animals: and 4. Man and vertebral animals. The
two last are obviously of more interest to us; but the deductions
from all aid materially in solving the great problem of the influ-
ence of physical agents on animal life. We shall therefore briefly re-
fer to the most prominent results contained in the two first parts,
and dwell more at length on those classes which are more closely re-
lated to man, and on the phenomena presented by man himself.
I. Batrachian reptiles. — The first topic of inquiry in this class of
the animated kingdom is into the phenomena of asphyxia; and espe-
cially, whether the medium, in which it may take place, has any pe-
culiar influence independently of that which is exerted on the lungs. Of
the media, the most important are air and water; and as reptiles have
the power of living a considerable time after the heart has been removed
from the body, the respective influence of these media can be readily
appreciated. By the removal of the heart, the circulatory and respi-
ratory functions are annihilated; the nervous and muscular systems
are alone left, and these are inseparably connected. Now, by placing
reptiles, whose hearts had been removed, in air and in water, and
observing how long they continued to live, a comparison could be
drawn of the influence of these media on the nervous and muscular
systems, independently of that which they exert on circulation and
respiration. This experiment was performed on salamanders, frogs,
and toads.
Two salamanders, deprived of their hearts, were placed in water of
the same temperature, which had been deprived of air by boiling; and
two in air. One of the former died in eight hours, the other in nine;
whilst those in air lived from twenty-four to twenty-six hours. The
experiments were repeated with similar results; whence Dr. Edwards
infers, that air, in comparison with water, has a superior vivifying in-
152 Edwards on the Influence of Physical *^gents on Life,
fluence upon the system of those animals, independently of its action
by means of circulation and respiration.
Similar experiments on frogs furnished analogous results. Those
in water lived two hours, those in air three.
'* If a frog", thus deprived of its heart, and immersed in water, be drawn out,
and exposed to the air, at the moment when all signs of life have disappeared,
it immediately begins to recover. If it be again plunged in water, all appearance
of life instantly ceases; and it may thus be made, several times alternately, to
lose and recover its motion and sensibility." " This," adds the author, " con-
firms, in a striking manner, the vivifying effect of air, and the deleterious influ-
ence of water on the nervous system." p. 10.
It is more probable, however, that the effect is exerted on the con-
tractility of the muscular fibre. Nasse has shown that water has the
eff*ect of destroying the irritability of muscles; and Dr. John K. Mit-
chell found, that when water was thrown into the heart of a Tes-
tudo serpent aria, or snapper, it was strongly stimulated, but its sub-
stance looked pale and hydropic, and in one minute action was de-
stroyed beyond recovery.
In these experiments, the functions of the nervous and muscu-
lar systems alone remained; but in ordinary asphyxia, circulation
continues iti those animals, although respiration has necessarily
ceased.
M. Edwards now attempted to ascertain the comparative duration
of life in frogs whose hearts had been cut out, and in those in which
they were left untouched. By placing these in water deprived of air,
the latter in some instances lived twenty hours longer than the
former; so that even the circulation of venous blood is favourable to
the action of the nervous and vascular systems. This is strikingly il-
lustrated in cholera, in which the activity of the nervous system, and
its power over the muscles, were exemplified after nothing but dark
blood was circulating in the vessels.
An interesting experiment was now made by strangling a number
of frogs, by means of a ligature passed round the neck. At first they
were paralyzed, but they afterwards recovered to a great degree, and
lived from one to five days. The resistance to the ordinary sources of
death, in the case of the amphibia, is most singular. Here we have
them subsisting for days, although strangled; and Dumeril had a sa-
lamander which survived decapitation long enough for the wound to
cicatrize.
It would seem, then, from the experiments of Dr. Edwards, that
the batrachian reptiles can live for many days by the aeration of the
Edwards on the Influence of Physical Agents on Life. 153
blood which is effected through the skin, and by the action of the
air on the nerves distributed to the cutaneous envelope.
That the blood is acted upon by the air was satisfactorily proved
by the quantity of carbonic acid exhaled from the surface of the body,
when strangled frogs were placed in receivers containing atmospheric
air — a fact clearly showing the existence of cutaneous respiration in
them.
In a former number of this Journal* we referred to certain experi-
ments that were instituted by Professor Buckland, connected with
the well-known fact of the capability possessed by toads of living for
a considerable length of time without air. Dr. Edwards is disposed
to think, that in all the instances on record, of toads having been
found imbedded in blocks of stone, there was probably some crevice,
forming a communication between the external air, and the cavity
containing the animal; but this, we think, is not proved. In the ex-
periments of our author, he found that toads, — and the same remark
applies to frogs and salamanders, — lived longer in sand or plaster
than in air, owing, he conceives, and we think properly, to the cuta-
neous transpiration being more abundant in the air than in the solid
substances, so that they exhaled, in the former case, the quantity of
water that was necessary to their existence, and consequently ex-
pired.
In some of M. Edwards's experiments on the duration of the life of
frogs inclosed in plaster, they did not survive more than six weeks|
but Herissant affirms, that he kept them alive for eighteen months.
All the results of the experiments were materially modified by vari-
ous circumstances, and one of the most important of these was the tem-
perature of the medium in which the animal was placed. It was found,
that as the temperature of the water of immersion was reduced, the
duration of the life of the frogs was extended, until at 32° Fahren-
heit, or the freezing point of water — it was more than tripled. On
the other hand, the elevation of temperature caused a corresponding
abbreviation of life, until, at 108° Fahrenheit, or about the natural
temperature of warm-blooded animals, death was almost immediate.
" At the freezing point the animal did not become torpid, but it was less ac-
tive; whilst the elevation of temperature aroused it to great agility.'* p. 17.
These results apply only to the asphyxiated animal. The frog,
whose respiration is free, may live in warm climates in water at
108°.
It appears, too, that season has a manifest influence on the dura-
* For May, 1833, p. 133.
154 Edwards on the Influence of Physical *Bgents on Life.
tion of life; — first, by the temperature of the water in which the ani-
mals are immersed; and secondly, by the influence of the tempera-
ture of the air for some days previous to the experiment; and when
these circumstances are combined the effect is doubled.
" On the 23d Nov. 1817, the air and water being at 10° cent, or 50° Fahr-
and the mean temperature of the month being- nearly the same; five frogs were
placed in water at the same degree. They lived from 5h. 10' to llh. 40'; the
latter period being about double the duration of life of these animals in water
at the same degree in summer. On the 22d Dec. the thermometer having been
about 0° cent, or 32° Fahr. for twenty days, three frogs were put in water at
10° cent, or 50° Fahr. ; they lived from twenty to twenty -four hours. On the
23d Dec. the temperature being still 0° cent, or 32° Fahr. four frogs were
placed in water at 0° cent, or 32° Fahr. the same apparatus being employed
as in the preceding experiments. They lived from twenty-four to sixty hours."
p. 20.
In the last experiment, consequently, they were placed in circum-
stances the most favourable for the prolongation of life under water.
The adult batrachians have only lungs, — organs adapted exclusive-
ly for atmospheric respiration. It becomes an interesting question,
therefore, to inquire how they are influenced by the air contained in
water, and whether they are not compelled, both in summer and
winter, to come to the surface to breathe. M. Bosc informed Dr.
Edwards, that he has seen the frog, during the winter season, quit
the water for several days in succession, at a certain hour, and take
breath for a short time on land; and if this be necessary in winter,
when the animal is less active, it must be still more so in summer.
To prove how far they are really influenced by the air contained
in water, our author first tried the effects of limited quantities of
water; and he found that frogs lived from three hours and forty mi-
nutes to five hours and thirty minutes in boiled water, whilst others,
in aerated water of the same tempera.ture, lived from six hours and
forty-three minutes to ten hours and forty minutes; — results which
showed that the air in the water has a decided influence in prolong-
ing the life of these animals within certain limits.
Another experiment proved most satisfactorily that frogs are truly
amphibious, or capable not only of breathing the air of the atmos-
phere, but also of living exclusively on the air contained in water.
By daily renewing stagnant water, a male frog, secured at the bot-
tom of a glass vessel, was kept alive for more than two months and a
half. Tadpoles can live in water without coming to the surface. They
have, however, gills as well as lungs, and hence resemble fishes.
They differ from the frog in not being able to live on land previous
to the full development of their limbs.
Edwards on the Influence of Physical Agents on Life. 155
The air contained in the water does not seem to act through the
medium of the lungs. Inspiration in frogs is performed bj a kind of
deglutition, and is accompanied by very evident movements of the
throat. In the atmosphere, these movements are repeated thirty or
forty times in a minute; but when the animal is plunged in water
they cease, and are not repeated; and if the lungs of the frog be ex-
amined no water is found in them, even when the immersion has been
prolonged. The air must consequently act on some other organ than
the lungs; and the skin is the only other organ in contact with the
fluid.
The experiments, previously referred to, having established the
fact of cutaneous respiration in the batrachians, Dr. Edwards next
attempted to discover, whether these animals could continue to live,
if permitted to breathe by the lungs alone, the atmosphere being al-
together excluded from contact with the skin; and he inferred from
his experiments, that —
** Pulmonary respiration is not sufficient to support the life of tree frogs,
without being accompanied by the atmospheric influence upon the skin. The
case is the same with the rana obstetricansy on which the experiment was also
tried, and we may conclude, that the observation applies to all the batrachians.
p. 41.
The attention of Dr. Edwards was next directed to the influence
of the atmosphere on the perspiration of those animals. This he
found to depend greatly upon the condition of the animal as to sa-
turation; and accordingly the loss by perspiration differs greatly; but,
taking the animal at the point of saturation or fulness, it is found to
lose less and less by perspiration in a given time, in proportion as it
removes from this point.
The quantity lost was found to depend greatly on the state of the
atmosphere, as to rest and motion: when the wind was strong, the
perspiration was quadrupled. It was to be expected likewise, that it
should differ according to the hygrometric state of the atmosphere.
Air, saturated with moisture, did not seem to prevent perspiration
altogether, although it reduced it to its minimum. We do not think,
however, that Dr. Edwards's experiments on this point were altogether
satisfactory. The animal was suspended in a glass vessel, inverted
over water, in which it would by no means follow, that the air should
be saturated with moisture. The function of transpiration being one
of depuration, must of necessity go on whether the air is saturated or
not. In dry air, the loss was from five to ten times greater than in
air of extreme humidity, according to the degree of dryness and the
duration of the experiment.
156 Edwards on the Influence of Physical Agents on Life,
As to the relative influence of different degrees of temperature upon
the quantity of perspiration, it was much less than was anticipated.
During five hours, the quantity perspired at 68° Fahr. was scarcely
twice what it was at 32° Fahr. and that at 104° Fahr. was seven
times greater than at S2° Fahr. ; — thus resembling the effects obtained
from a dry and still, compared with a humid atmosphere.
Another important topic of inquiry was, how the weight of the body
is influenced by the contact of water with its external surface? That
water was absorbed was manifest, and the weight of the body was
found to increase or diminish, according as either of the antagonist
functions of absorption and transudation exceeded the other. At
32° Fahr. the absorption predominated,* at 86° the transpiration.
Thus much, as regards the batrachian reptiles.
II. Fishes and reptiles. — The first stage of the life of batrachian
reptiles, or the tadpole state, is so peculiar as to have induced the
author to consider it under this head. The chief peculiarity consists
in their possessing two kinds of respiratory organs — lungs and gills.
*' Tadpoles unite in regard to respiration, the functions of reptiles with those
of fishes; their use of them varies, not only according to their development, but
also according to their physical conditions, under the influence of which we
are now about to consider them. The tadpole has, in common with the adult
animal, the power of supporting life through the medium of the skin, by means
of the air contained in water. It has already been shown, that the limits of tem-
perature in which the adult animals are able to exist, are 32° and 50° Fahr.
or 0° and 10° cent.; and that beyond the higher limit, the greater part were ob-
liged to have recourse to atmospheric respiration; but tadpoles, having an ad-
ditional organ, by which they are enabled to avail themselves, in a higher de-
gree, of the vivifying influence of the air contained in water, ought, we would
imagine, to support, under water, a much greater elevation of temperature,
without having recourse to the external air. That this is actually the case, is
shown by experiments in which they were kept a long time in vessels with the
water occasionally changed, and in running water, at the temperature of 25°
Cent, or 77° Fahr." p. 52.
The most important of Dr. Edwards's inquiries was into the in-
fluence of physical agents on the transformation of the tadpole into
the frog. This is known to be expedited by a due supply of nutri-
tious matter, and to be retarded when the supply is scanty.
The effect of temperature is also signal. If the tadpole is produced
late in the summer, the subsequent temperature not being sufficiently
elevated, it passes the winter in the larva state, and does not quit it
until the return of warm weather. The results of the experiments,
instituted by our author, further showed, that if deprived of atmos-
pheric respiration they would retain their original form under water,
Edwards on the Influence of Physical *^genis on Life. 157
if their nutriment were not too abundant, and the temperature were
not too high; and that the difference of atmospheric respiration alone,
joined to these circumstances, would determine the transformation.
It will be seen afterwards, that privation of light has a great effect
in retarding and modifying their development.
Experiments were made on fishes similar to those on the batrachian
reptiles; and first, as regards the influence of temperature on their
lives in water deprived of air. Comparative experiments were made
on individuals of the same species, at temperatures varying from 32°
Fahr. to 104°. The result was, that at the higher limit death was
as speedy as in the case of the batrachians, and the duration of life
was progressively greater in proportion as the temperature was re-
duced to the lower limit. It appeared, however, that the smaller and
the younger the fish, the less capable was it of bearing an elevation
of temperature. At 104° the small fish do not live more than two
minutes, whilst the larger survive several minutes longer. These re-
sults only apply, however, to the case of fishes inhabiting water of
the ordinary temperature of the climate. De Saussure, Sonnerat,
Bruce, Abel, Lamarck, and others, sufficiently show, that these
animals may breed, and live in water of a much more elevated tem-
perature. Humboldt and Bonpland saw them thrown up alive fro
the bottom of a volcano, the steam of which raised the thermometer
to 210° Fahr.
His next inquiry was into the influence of the temperature of aerated
water in limited quantities in close vessels, and from a number of ex-
periments he deduced the following inferences;^rs/, that the dura-
tion of life goes on increasing with an increase of the quantity of
aerated water, the temperature remaining the same; secondly, that
the same result takes place when, the quantity of water remaining
the same, the temperature is lowered; and thirdly, that the duration
of life remains the same, when, within certain limits, we increase or
diminish at the same time both the temperature and the aerated water.
p. 57.
I'he influence of temperature on fishes was found to resemble that
on the batrachian reptiles. If a bleak (Cyprinus alburnus) be put
into a vessel with a large mouth, containing five ounces and a half of
aerated water, at 68° Fahr., in summer, it dies within a few hours;
but when the temperature is lowered to 50° or 53° Fahr. and is kept
at that point, the animal lives until its secretions are so abundant as
to corrupt the water; and if the water be renewed QWtvy twenty-four
hours, it lives in it almost indefinitely.
From all his experiments connected with this subject, the author
No. XXVII.— xMay, 1834. 14
158 Edwards on the Influence of Physical Agents on Life.
deduces, that the more the temperature is raised beyond certain
limits, the greater is the degree of influence of the air required for
their support.
The experiments of Sylvestre and others had sufficiently shown,
that atmospheric respiration has an influence on the life of fishes —
that it tends to prolong their existence in water. It became interesting,
however, to examine into the circumstances connected with their life
in the air. When a fish is taken from the water, it dies in a few
minutes, or in a few hours, according to the species; and hence it has
been inferred, that fishes are incapable of living by atmospheric re-
spiration, or that air in this form is unfit for their continued existence.
From a series of well-devised experiments, it was further shown —
" That the life of fishes in the atmosphere depends on several conditions,
of which the principal are, temperature; the capacity of saturation with water;
the corresponding loss by perspiration from the trunk and gills; the quickness
of this loss; the action of the muscles which move the gills; and the use which
they make of their muscles to avail themselves of the action of the air upon the
gills. In short, they come under the general law relative to the influence of
the atmosphere on the life of vertebrated animals. As fishes seem to form an
exception to this law, I have thought it necessary to show that they are so only
in appearance. "What has been here stated relative to the life of fishes in the
atmosphere, is equally applicable to tadpoles, placed in the same circumstances.
They die from the quantity of water which they lose by perspiration; and al-
though their capacity of saturation is, at least, equal to that of frogs, since it
varies between one-third and one-fourth of their weight, yet as their size is
very small, and their perspiration rapid, on account of the delicacy of their skin,
they soon lose that proportion of water, and in the experiments which I made,
I found that they did not live more than four hours." p. 64.
Similar experiments were made on lizards, serpents, and tortoises;
in other words, on the saurian, ophidian, and chelonian reptiles,
which showed, that as regards the action of the atmosphere, the ge-
neral results are the same with all cold-blooded animals: modified,
however, by the character of the external covering, as respects its
porosity and thickness.
III. Warm-Uooded animals. — This and the following part are
possessed of more interest to us than those to which we have attend-
ed, and are more calculated to aid us in determining many import-
ant topics of physiological and pathological inquiry. The first
chapter is on the heat of young animals.
It has been a universal opinion, owing to the circulation of young
animals being more rapid, and the function of nutrition more active,
that their temperature is much higher than that of adults. The opi-
nion is not sanctioned by observation. When new-born animals are
Edwards on the Influence of Physical Agents on Life. 159
examined, the temperature, if placed near the mother, is never found
to be superior to that of the adult. But if when the temperature is
from 50° to 68° Fahr. a new-born puppy be removed, and kept an
hour or two from its mother, the temperature falls considerably, and
continues falling, until, in the course of three or four hours, it stops
at a very few degrees above that of the surrounding air. The heat
begins to subside as soon as the separation takes place, and the dimi-
nution is not in the least retarded by furnishing the animal, from
time to time, with milk. So that it would appear, from these and
other experiments, that the young animal, of certain species at least,
produces less heat in a given time than the adult. As it advances in
life, the diminution, under the circumstances mentioned, takes place
more slowly, and to a less and less extent; until, at the end of a
fortnight, it will maintain itself at a degree nearly equal to that of
the parent. The new-born puppy would seem, consequently, to re-
semble the cold-blooded, rather than the warm-blooded animal, the
characteristics of the latter being acquired gradually.
The same phenomena were found to take place with kittens and
rabbits, but not with the young of all the mammalia — with the young
Guinea-pig for example. The young of the mammalia seem, there-
fore, to be divided into two groups, in relation to animal heat; some
being born, as it were, cold-blooded; others warm-blooded.
Now, corresponding to this difference, there appears to be another,
deducible from the state of th-e eyes. Some are born with the eyes
closed; others with them open; and until the eyes are opened they
resemble the cold blooded-animal; those that are born with the eyes
open being warm-blooded from birth.
** Thus," says Dr. Edwards, *' the state of the eyes, though having" no imme»
diate connexion with the production of heat, may yet coincide with an internal
structure influencing that function, and certainly furnishes signs which serve to
indicate a remarkable change in this respect; since, at the period of the opening
of their eyes, all young mammalia have nearly the same temperature as adults."
p. 70.
Analogous results were obtained in the case of young birds, — the
experiments being all admirably arranged, so as to prevent the exist-
ence of any source of fallacy, — but here again a difference was per-
ceptible in different birds, some being, like the young Guinea-pigs,
capable, as soon as they are extruded, of maintaining an elevated
temperature, if exposed to the air in a favourable season. None, how-
ever, have the power of preserving their temperature, when the season
is very severe, owing to the young possessing to an inferior degree
the power of producing heat.
160 Ya^w^x^?, on the Influence of PhysicalJlgents On Life.
We may conclude, then, that the power of producing heat, in warm-
blooded animals, is at its minimum at birth, and increases successive-
ly, according to our author, until adult age.
The singular phenomena o^ torpidity^ which has engaged the atten-
tion of so many physiological naturalists of eminence, could not fail
to attract that of Dr. Edwards. The hibernating animals — as the bat,
hedgehog, dormouse, garden dormouse, and the marmot, possess all
the characteristics of the mammalia, and are distinguished from the
others only by their hibernation; during the existence of which they
are converted, for the time, into cold-blooded animals; — their tem-
perature being scarcely higher than that of the surrounding atmos-
phere; their respiratory movements irregular, feeble, and at long in-
tervals; and no nourishment being taken during the whole period,
which continues for several months.
The attention of observers — of Spallanzani, Hunter, Mangili,
De Saissy, and others — has been principally bestowed on these ani-
mals during the period of hibernation; upon the mode of resuscitating
them, as it were, and of again throwing them into torpidity. The re-
searches of M. Edwards were directed chiefly to the phenomena
connected with their temperature, which seem to influence all the
others.
The spring and summer temperature of these animals has been
found equal to that of many other mammalia, 98°. 6 of Fahr.; but the
following experiment of M. Edwards, essentially resembling some
performed by M. De Saissy, shows that they produce less heat.
In April, 1819, the air being at 61° Fahr. an adult bat, of the long-
eared species, recently taken, in good condition, and at the tempera-
ture of 93° Fahr. was placed in an earthen vessel, which was cooled
by a mixture of ice and salt, till the air within was reduced to 33°. 8
Fahr. The vessel had a cover, which allowed a free communication
with the external air. After the animal had been there for an hour,
its temperature was reduced to 57"" F. ;— a loss in this short space of
time of 36° F. Guinea-pigs and adult birds, placed in the same cir-
cumstances, lost, at the utmost, not more than two or three degrees,
although the influence of the cold was prolonged, in their case, to
compensate for the difference of size.
Hence it appears, that bats produce less heat than animals which
do not hibernate. To this cause must be ascribed the reduction of their
temperature during the cold season; and it applies to all hibernating
animals as well as to the bat.
From this inquiry the transition was natural to that, — whether in
the opposite seasons of winter and summer, warm-blooded animals,
Edwards on the Influence of Physical Agents on Life. 161
not hibernating, presented any difference in regard to their power of
producing heat? This was to be ascertained by placing animals of the
same species in the same conditions of refrigeration in winter and
summer, and observing whether their temperature diminished un-
equally.
"It is necessary," says M. Edwards, "in the first place, that the animals se-
lected should be as similar as possible, and that the experiments should be suf-
ficiently numerous to obviate any considerable influence from individual di-
versities. In order that the mode of refrigeration should be the same, atten-
tion must be paid, not only to the temperature, but to the humidity of the at-
mosphere; for a difference in the hygrometric state of the air would produce a
corresponding difference in the evaporation from the lungs and skin, and con-
sequently in the quantity of heat lost.
*'The apparatus consisted of glass vessels, of the capacity of two pints,
placed in a freezing mixture of salt and ice. The air, thus cooled, is at its point
of saturation with rnoisture. When it is at zero cent, or 32° Fahr. the animal
is introduced, and placed on a false bottom of gauze, to prevent the contact of
the cold glass. A lid covered with ice is placed over the vessel, but so as to
permit change of air for the free exercise of respiration; and, in order more ef-
fectually to secure the purity of the air, a concentrated solution of caustic po-
tass is placed at the bottom, to absorb the carbonic acid, which it readily does,
through the gauze." p. 82.
The general results were as follows: — In the month of February
the experiment was made, at the same time, upon live adult sparrows.
In the course of an hour, they lost, on an average, 7°. 2 Fahr., some
having lost nonei others only 1°.8 Fahr. Their temperature then re-
mained stationary, until the end of the experiment, which lasted three
hours. In July the same experiment was tried on four others. Their
temperature, in the course of the first hour, sustained an average loss
of 6°. 5 Fahr. 5 at the end of the third hour the average reduction from
their original temperature was 10° Fahr. In another series of experi-
ments on six sparrows, in the month of August, the mean loss of tem-
perature, at the end of the first hour, was 2°. 9; and after three hours
30.76: — experiments which would seem to show, that continued ele-
vation of temperature diminishes the power of producing heat, whilst
an opposite state of the atmosphere, provided the cold be not too se-
vere, increases it.
The hope of producing such a change in animals as might enable
them to support the privation of air for a much longer period than is
natural to them, and to become aquatic animals, led Buffon to the
discovery of a singular fact connected with young animals. He
placed a greyhound bitch, of the large species, when on the point of
giving birth to young, in a tub of warm water, and secured her ii?.
14*
162 Edwards on the Influence of Physical Sgents on lAfe.
such a manner that she was obliged to bring them forth under water.
These were afterwards, for the sake of nourishment, transferred to a
smaller tub of warm milk, but without giving them time to breathe.
Thej remained there for above half an hour, after which they were
taken out, and all found alive. They began to breathe, which they
were permitted to do for half an hour, and were then again plunged
in the milk, which had been warmed again in the mean time. There
they remained for another half hour, and when they were again taken
out, two were quite strong, and seemed not to have suffered at all.
The third appeared drooping, but was carried to its mother, and soon
recovered. The experiment was continued on the other two: they
were allowed to breathe a second time for about an hour; and were
then plunged once more in the warm milk for half an hour, after
which they appeared as strong as before. Being taken to their mother,
however, one of them died the same day, whether by accident, or
from the privation of air, could not be ascertained. The other lived
as well as the first; and both throve as well as the other puppies pro-
duced after the bitch was removed from the water, and which had not
been experimented upon.
Some similar experiments were made by Le Gallois on rabbits,
which would favour the belief, that the duration of the life of new-
born mammalia, under such circumstances, is about half an hour.
Yet M. Edwards was surprised to find, that the Guinea-pig, at birth,
when plunged in water, lived only three or four minutes longer than
the adult, and in other animal species the difference was not greater.
On inquiring into the causes of this difference, he found that those
animals which, when asphyxiated, give signs of life for half an hour,
are the very species that possess feeble powers for the production of
heat — new-born dogs, cats, and rabbits, for example. It was before
observed, that these animals, at this period of existence, strongly re-
semble fishes, and these facts show that they resemble them further
in the power of sustaining privation of air. On the other hand. Gui-
nea-pigs are in the class that produce most heat at birth, and of these
the author says he has never seen one which lived above seven mi-
nutes under water.
" We have seen," says M. Edwards, " that at the end of the fifth day the du-
ration of life during- asphyxia is reduced one-half: now this reduction corres-
ponds to a sensible elevation of their temperature. The same is the case after
the second interval of five days; the heat is then much increased, and the power
of living without respiration is considerably diminished. Lastly, when they have
arrived at the fifteenth day, a period when they usually have a temperature
nearly equal to that of adults, they scarcely differ from them in the duration of
Edwards on the Influence of Physical Agents on Life, 163
asphyxia. If, instead of passing at once from the first to the fifth day, we exa-
mine the young- animals in the intervening days, we shall find, that during the
first and second, and even riot unfrequently the third, the duration of asphyxia
is only very slightly altered. The production of heat corresponds with this, and
both phenomena likewise concur in the more rapid and striking change that
quickly after takes place.
" We see that the distinction formerly pointed out between young mammalia,
founded in the production of heat, is applicable to them, also, in respect to the
duration of life, when deprived of respiration. This duration has its maximum
in the group of mammaha which produce the least heat at birth, and its mini-
mum in those which produce the most." p. 88.
The external temperature has likewise an influence on the dura-
tion of asphyxia in these cases. Some kittens, when a day or two
old, were subjected to water, cooled to 32° Fahr.; thej ceased to
give signs of sensibility and motion after four minutes and thirty-three
seconds, taking the mean of nine experiments. At a temperature of
50° Fahr. the duration of life extended to ten minutes and twenty-
three seconds; at 68°, to thirty-eight minutes and forty-five seconds.
At 86°, however, they lived but twenty-nine minutes, and at 104°,
but ten minutes and twenty-seven seconds; — so that there are two
principal conditions which influence the life of warm-blooded animals
when deprived of air; namely, the quantity of heat developed by the
animals themselves, and the external temperature to which they are
exposed.
In his experiments upon the respiration of this class of animals,
M. Edwards found that the young are capable of living much longer
than the adult in the same quantity of air; and consequently, that
their consumption of the air in respiration is comparatively less. So
that the adult animal, whose power of producing heat is great, con-
sumes more air than the young animal, whose calorific powers are
less. Here, again, a difference existed between Guinea-pigs and pup-
pies. The latter were removed from the confined space at the end of
four hours and fifty-nine minutes, the former after an hour and forty-
two minutes. A recollection of the fact, that young puppies at birth
produce much less heat than Guinea-pigs, will explain the apparent
anomaly.
It was before remarked, that the power of producing heat in warm-
blooded animals, is greater in winter than in summer; and the expe-
riments of M. Edwards showed that the consumption of oxygen is
more rapid in the former season.
The researches of our author on the perspiration or exhalation of
warm-blooded animals, led him to the following results: —
" That the successive losses by perspiration are subject to considerable varia-
164 Edwards on the Influence of Physical *^gents on Life.
tions and alternations of increase and diminution, when compared at short Inter-
tervals, but constantly decrease when considered at longer periods. The pe-
riods during- which the fluctuations takes place in vertebrated animals general-
ly, may be pretty accurately determined. We have always observed, in warm-
blooded animals, the alterations to take place with intervals of an hour, and this
term may be regarded as a general rule. On examining the whole series of ex-
periments upon vertebrata of different classes, it was observed that the shortest
intervals within which the successive diminution took place were those of two
hours, and the longest, nine. In taking a mean of six, we may hope to include
almost all the cases, for even when a longer space of time was necessary, three
hours were sufficient to determine a diminution, if not constant, at least with
little variation. In the greater number of cases, it took place in successive in-
tervals of three hours." p. 105.
The main results were found to be conformable to those obtained
on cold-blooded animals. In the former, however, the perspiration
was found to be six times greater in dry than in moist air. The influ-
ence of air in motion, and air at rest, on the function of perspiration,
was found to be analogous to that experienced in the cold-blooded
animal.
IV. Man and vertebrate animals. — The effect of various physical
influences on these upper classes of created beings are of most mo-
ment to us, although nothing can be more instructive to the scientific
anthropologist than an investigation of similar influences on animals
lower in the scalej from which, by invoking a wise analogy, infer-
ences may be drawn that tend largely to elucidate many obscure phe-
nomena presented by man himself.
*' The results," says our author, " obtained in my experimental inquiries into
the influence of physical agents on other warm-blooded animals have been so
uniform, that they may, by analogy, be extended to man, although he can
scarcely be made the subject of the experiments themselves, and for this reason
was not mentioned in the preceding part." p. 112.
The first chapter of this division is on the modifications of heat in
man^from birth to admit age; and here we observe, at once, the
striking analogy to the warm-blooded animals in general. It was
before stated, that those which are born with the eyes closed, lose
their heat when they are exposed to the air in spring or summer, al-
most as rapidly as cold-blooded vertebral animals; whilst those whose
eyes are open at birth, under similar circumstances, preserve a high
and constant temperature. In accordance with analogy, a new-born
infant, at the full period, having t)ie eyes open, should have the
power of maintaining a pretty uniform temperature during the warm
seasons; but if birth takes place at the fifth or sixth month, the case
Edwards on the Influence of Physical Agents on Life. 165
is altered,* the pupil is generally covered with the membrana pupilla-
ris, which places the animal in a condition similar to that of closure
of the eyelids in other animals. Analogy would induce us to conclude,
that in such an infant the power of producing heat would be inconsi-
derable. Observation confirms this; although we obviously have not the
same facilities, as in the case of animals, of exposing the young to a
depressed temperature. On taking the temperature of twenty adults,
it was found to vary from 96° to 99° Fahr. the mean being 97°;
whilst the temperature often healthy infants varied from 93° to 95°
Fahr. the mean of the whole being 94°. 55.
The temperature of a seven months' child, though well swathed,,
and near a good fire, was, within two or three hours after birth, no
more than 89°.6 Fahr. Before the period at which this infant was
born, the membrana pupillaris disappears; and it is probable, as Dr.
Edwards has suggested, that if it had been born some time before the
disappearance of the membrane, its power of producing heat would
have been so feeble, that it would scarcely have differed from that of
mammalia born with the eyes closed.
These facts suggest another most important object of inquiry, re-
garding the influence of cold on mortality at different periods of life.
If the faculty of evolving heat differs, vitality will be correspondingly
modified; and the temperature of the atmosphere has to be guarded
against by proper precautions, especially where the capability of
evolving heat is feeble.
Now, as this capability is less in the infant at birth than it is sub-
sequently, it requires the assistance of external warmth more than
it does subsequently, and it is probable that contact with the mother,
so strongly suggested by the maternal feelings and instincts, is es-
sential to the due maintenance of the vital energies.
The following experiments are full of interest in this point of view.
*' On 12th February 1819, a kitten, newly littered, removed from its mother,
and exposed to the air, at the temperature of 14° cent, or 51° Fahr. being- cool-
ed down in nine hours to 18° cent, or 64°.4 Fahr. became stiff, and almost inca-
pable of executing the slightest movements.
" The following month the air of the room being 10° cent, or 50° Fahr., I ex-
posed two kittens, of one day old, and having a temperature of o7° cent. 98°. 6
Fahr. In 2h. 25, the temperature of one was reduced to 17° cent, or 62°. 6
Fahr. and that of the other to 18° cent, or 64°.4 Fahr. They had become stiff
and almost insensible.
" In the month of January in the same year, four puppies littered the day
before, were of the temperature of 35° to 36° cent, or 95° to 97° Fahr. The
air of the room was 11° cent, or 52° Fahr. The cooling which they underwent
166 Edwards on the Lijliience of Physical Agents on Life.
from nine in the morning- till ten at night, lowered their temperature to 13° and
14° cent, or 55°.4 and 57° Fahr. They were then so enfeebled that they were
almost motionless.
"The symptoms of weakness and sufTering soon after the young animals are
exposed to the air, increases as their temperature sinks. The same circumstances
occur with those young birds which produce the least warmth when hatched.
" Although the diminution of temperature thus occasioned by exposure to
the air, would ultimately prove fatal to these young animals, it is remarkable
how long they are capable of enduring a considerable reduction of temperature.
New-born puppies or kittens may live two or three days at a temperature of 20°
cent, or 68° Fahr. and even 17° or 18° cent, or 62°.6 or 64°.4 Fahr. But the
air must not be too cold, or they would soon be deprived of sense and motion,
and in a short time this apparent death would become real. When they ap-
peared on the point of expiring, I easily restored animation by placing them
before the fire or by immersion in a bath. These means, if promptly applied,
may even prove effectual when they are quite motionless, and, to all appear-
ance, dead." p. 119.
It appears, then, that these animals bear a considerable reduction
of their temperature, but they must not be left too long in the state
of reduction; and due care must be taken in the restoration ot warmth.
If the exposure be too often repeated, or too long continued, it is
fatal; and the facility of recovery after great reduction of tempera-
ture, does not continue in the same degree in the progress of life.
The reduction of bodily temperature is therefore less injurious in its
permanent effects, in proportion to the youth of the animal.
It has been observed, that in young warm-blooded animals, the ca-
pability of supporting reductions of temperature is inversely propor-
tionate to their power of producing heat, and this appears to be a
wise provision of nature; for whatever care may be taken by parents
of their young, they cannot always remain with them to maintain
their temperature at a high degre6, if they belong to the class of ani-
mals that are born with closed eyes, or without feathers.
*' As soon as they leave them to provide subsistence, the temperature of their
young begins to be reduced, and if this reduction were as injurious as it is to
those animals which produce more heat, the greater part would perish." p. 121.
The following is a general review of the facts relative to the influ-
ence of cold at the different periods of life.
**We must distinguish two things — the cooling of the body, and the tempera-
ture capable of producing it. The cooling of the body, without regard to its
cause, is less injurious in proportion to the youth of the animal. Lower the
temperature of two animals of the same species an equal number of degrees,
the young will suffer less, and will recover more perfectly. But, in order to
lower the temperature of animals of different ages, different degrees of external
Edwards on the Influence of Physical *^gents on Life. 167
cold will be necessary, being lower, the nearer the animal is to adult age. If,
on the other hand, young animals suffer less from the same reduction of warmth,
on the other hand, they cool more readily. It is on this last circumstance, that
the mortality in warm-blooded animals, at different periods of life from birth to
adult age, principally depends, so far as it is the result of the influence of ex-
ternal cold." p. 122.
When the momentary application of cold is frequently repeated,
the power of producing heat becomes enfeebled, and it takes some time
for the organs of calorification to recover their power: on the other
hand, after exposure to cold sufficient to diminish the power of pro-
ducing heat, continuance in a high temperature tends to the recovery
of this power, for on exposing animals to successive applications of
cold, their temperature is found to fall the more slowly the longer
they have been subjected to the influence of warmth. Hence, persons
who are liable to frequent exposure to severe cold, are rendered
more capable of supporting it, by subjecting themselves, in the inter-
vals, to an elevated temperature. The transient application of heat
consequently occasions effects, which are continued beyond the time
of the application, and it operates whenever the system stands in
need of heat.
The experiments of Le Gallois, as well as those instituted by him-
self, have induced M. Edwards to infer, that there is always a cer-
tain ratio between heat and respiration in both the cold-blooded and
warm-blooded animals; and in hibernating animals both in the periods
of torpidity, and of full vital activity. When the eighth pair of nerves
is cut in the young of the mammalia, a considerable diminution is pro-
duced in the opening of the glottis, so that in puppies, recently born,
or one or two days old, so little air enters the lungs, that when the
experiment is made in ordinary circumstances, the animal perishes as
quickly as if it was entirely deprived of air. It lives about half an
hour. But if the same operation be performed upon puppies of the
same age, benumbed with cold, they will live a whole day. In the
first case, the author thinks, and plausibly, the small quantity of air
is insufficient to counteract the effect of the heat; whilst in the other,
it is sufficient to prolong life considerably; and he deduces the fol-
lowing practical inferences applicable to the adult age, and parti-
cularly to man.
" A person is asphyxiated by an excessive quantity of carbonic acid in the
air which he breathes; the beating of the pulse is no longer sensible, the respi-
ratory movements are not seen, his temperature however is still elevated. How
should we act, to recal life? Although the action of the respiratory organs is
no longer visible, all communication with the air is not cut off. The air is in
contact with the skin, upon which it exerts a vivifying influence; it is also in
i 68 Edwards on the Injluence of Physical Agents on Life.
contact with the lungs, in which it is renewed by the agitation which is con-
tantly taking place in the atmosphere, and by the heat of the body which rari-
fies it. The heart continues to beat, and maintains a certain degree of circula-
tion, although not perceptible by the pulse. The temperature of the body iS
too high to allow the feeble respiration to produce upon the system all the effect
of which it is susceptible. The temperature must then be reduced, the patient
must be withdrawn from the deleterious atmosphere, stripped of his clothes, that
the air may have a more extended action upon his skin, exposed to the cold,
although it be winter, and cold water thrown upon his face until the respiratory
movements reappear. This is precisely the treatment adopted in practice to
revive an individual in a state of asphyxia. If instead of cold, continued warmth
were to be applied, it would be one of the most effectual means of extinguish-
ing life. This consequence like the former, is confirmed by experience.
" In sudden faintings, when the pulse is weak or imperceptible, the action of
the respiratory organs diminished, and sensation and voluntary motion suspend-
ed, persons the most ignorant of medicine are aware that means of refrigeration
must be employed, such as exposure to air, ventilation, sprinkling with cold
water. The efficacy of this plan of treatment is explained on the principle before
laid down.
*' Likewise in violent attacks of asthma, when the extent of respiration is so
reduced that the patient experiences suffocation, he courts the cold even in the
most severe weather, he opens the windows, breathes a frosty air, and finds
himself reheved." p. 149.
As a general rule, an elevated temperature accelerates the respi-
ratory movements, but the degree of temperature requisite to pro-
duce this effect, is not the same in all. The object of this is, that
more air shall come in contact with the lungs in a given time, so as
to reanimate what the heat depresses.
In young animals, especially such as are born without the power
of maintaining their temperature in the open air, as soon as they are
exposed to cold the respiration increases in rapidity and extent, and
their temperature begins to fall. They present, according to our au-
thor, the phenomena of an attack o{ fehris algida^ and this state is
quickly fatal, if not remedied by renewing the heat of the body.
" Although the acceleration of respiration is a powerful means of counter-
acting the effects of cold, by extending the contact of the air with the organs
best adapted to feel its vivifying influence, this acceleration has its hmiis: it
may diminish, but cannot compensate for the effects of excessive cold.
In tiie progress of life, however, these young beings are less and
less affected in their respiratory movements by the same tem[)erature,
until it ultimately has no influence over them, so that in adult age,
the rapidity of their respiratory movements is much less subject to be
influenced by external temperature: yet in them, if the cold be car-
ried sufficiently far, an acceleration takes place in the respiratory
Edwards on the Influence of Fhysical Agents on Life. 169
movements, until, the powers being exhausted, these movements, like
all the others, languish, and fail.
From these and other facts, it w^ould seem to follow, that when
an individual experiences a change of constitution, which diminishes
his production of heat, or consumption of air, he cannot endure that
degree of cold, which previously would have been salutary to him,
without experiencing, sooner or later, an alteration in the rate of his
respiratory movements.
** Hence the necessity, when these two functions have experienced this altera-
tion, as in cases of organic affection of the heart and lungs, of placihg the pa-
tient in communication with a milder temperature, either artificially, or by
change of climate." p. 156.
If an individual be kept quiet, and abstain from food, and sleep,
his perspiration may be regarded as uniformly diminishing in each
succeeding period of six hours:* in some a longer period may be neces-
sary, in others a shorter. In some, M. Edwards thinks, successive
diminution of perspiration may be observed in periods of three hours,
but this he considers to be the minimum. The period of the greatest
perspiration, when no obstructing cause exists, is generally, accord-
ing to him, from the hour of rising in the morning — say six o'clock —
till noon, and the losses are successively less in similar intervals, for
the remainder of the twenty-four hours.
The hygrometric condition of the atmosphere, the state of motion
and rest of the air, and the pressure of the atmosphere, have the same
influence over this function in man as in animals.
Dr. Edwards, however, considers that these conditions affect only
the insensible perspiration, or that which is produced by evaporation^
but they do not produce sweat, which he regards as a process of
transudation^ thus making, with Haller, the insensible and sensible
perspirations two distinct functions, although it appears to us there
is not sufficient ground for the distinction. The insensible perspira-
tion he looks upon as a purely physical phenomenon, whilst the sen-
sible "is a loss ordinarily produced by a vital action, in the form of
a liquid which transudes^" but even were we to admit the difference,
the altered characters of the air might exert a decided effect on the
cutaneous capillaries that are charged with the secretion. If the air,
for example, be loaded with moisture, the perspiration cannot pass
off, but accumulates on the surface, and under such circumstances it
* These periods are chosen to obviate the influence of the constant fluctua-
tions that are observed in the amount of the perspiration at short intervals.
No. XXVII.— May, 1834. 15
170 Edwards on the Influence of PhysicalJlgents on Life,
is probable, that the activity of the vital operation would be less than
where it can readily be exhaled as it is formed. The vessels of the
skin we regard as depuratory organs, like the kidneys, and we think
this applies to thern as organs of the insensible as well as of the sensi-
ble transpiration. It cannot be denied, however, that a certain ex-
tent of evaporation of fluids may take place in the living as well as
in the dead body, and the loss, produced in this way, must be added
to that experienced through the function of perspiration.
On the effect of suppression of perspiration M. Edwards expresses
himself in a rational and sound manner. It has always appeared to
us, that this has been too blindly invoked as a cause of disease; and
that the morbid influence, in such cases, is rather to be ascribed to
the induction of irregular action of capillaries, extending its mor-
bific eflfects to other portions of the frame, than to any check given to
the cutaneous transpiration.
" All that we have hitherto shown on the subject of perspiration will consi-
derably facilitate our examination of a question which naturally presents itself.
Is perspiration susceptible of being- suppressed.'' It is easier to resolve this ques-
tion with regard to man and other warm-blooded animals, than with respect to
the cold-blooded vertebrata. Let us see what is the result of a \^vy low tem-
perature upon warm-blooded animals. We know, by the effect of cold upon
the sweat, that it diminishes transudation. Now let us suppose that It may, by
its intensity, suppress it altogether, there will remain perspiration by evaporation
which will always take place however humid the air may be. The high tem-
perature of man and other warm-blooded animals, warms the ai'r in contact with
the body, and changes its hygrometric state by removing it from its extreme
of humidity, and consequently occasions evaporation. If, on the other hand, the
temperature of the air be raised to an equality with that of the body, at the time
that it is saturated with humidity in order to suppress evaporation, then per-
spiration by transudation is excited, and takes place to such an extent in man
and other warm-blooded animals, that the sweat will stream from all parts of the
body. We can then in no case suppress their perspiration; it will be performed
either by evaporation or by transudation. We ought therefore to be careful
how we take hterally what we find in medical books respecting suppressed per-
spiration. There can be no such thing. That there may be suppression of
sweat, is evident to every one; but it does not follow that even in these cases
there is no transudation.
" Since it is difficult to assure ourselves directly whether transudation is ever
entirely suppressed in man and other warm-blooded animals, let us see what the
cold-blooded vertebrata will offer on this point.
" The batrachians are the best adapted to this kind of researches, on account
of the nakedness of their skin, of the fineness of its texture, of the copious loss
which may be incurred through its medium, and consequently of the relation
which their perspiration bears to that of man.
*' On exposing frogs to the temperature of 0° cent. 32° Fahr. in humid air, in
Edwards on the Influence of Physical Jigents on Life, 171
order to suppress perspiration by evaporation, they have lost by transudation,
in different experiments, the 30th part of their weight. Transudation is more
abundant in these animals than in man, though the latter be placed in circum-
stances much more favourable. When we consider how sensible these creatures
are to cold, how much the activity of all their functions is diminished at a low
temperature, and how much they may even then lose by transudation, it is not
to be supposed that cold suppresses this mode of perspiration in man, and the
less so from his having a temperature of his own which varies very little with
the changes of the atmosphere, a condition which has a powerful tendency
to maintain transudation. It may be very much diminished by the action of cold
but it appears that it cannot be altogether suppressed.
"It is a remarkable, but well-known fact, that when life is sinking, and to
appearance nearly extinct, the body is covered with sweat — so strong is the
tendency to continue this function."
Lastly, as the author has properly remarked, if the body were im-
mersed in a denser medium than air — in water, for instance, sup-
posing that it had no physiological action on the skin, it would merely
prevent the contact of the air, and consequently suppress evapora-
tion; but the vital action of the perspiratory vessels would continue,
although we cannot think to the same extent, as in the air; but the
deficient depuration would probably be made up by exhalation from
the lungs and kidneys.
On the question, whether absorption of water takes place through
the skin in man, M. Edwards is in the affirmative. He has no doubt,
too, that it is readily effected when the body is placed in humid air.
The experiments on this subject by Sanctorius, Seguin, Rousseau,
&c. are sufficiently discrepant, but still we think enough has been
done to demonstrate, that cuticular absorption is not easy; and that
one of the great uses of the cuticle is to obviate the evils that might
result, provided it were more readily effected. Yet the lizard, whose
skin is scaly, after having lost weight by exposure to the open air,
recovers its weight and plumpness when placed in contact with water,
and if the scaly skin of the lizard permits such absorption, Dr. Ed-
wards thinks it is impossible not to attribute this property to man.
The experiments of Seguin and Rousseau exhibit, as we have
remarked, that this is by no means easy, but we can readily con-
ceive, from the facility with which water soaks through animal tissues,
that if the animal body be immersed sufficiently long in it, and es-
pecially if the vessels have been previously drained, imbibition might
take place to a considerable extent, until a state of healthy fulness
were induced. But this would be a mere mechanical, or physical ab-
sorption, and could be effected in the dead body as well as in the
living.
172 Edwards on the Influence of Physical Agents on Life.
In the chapter on Temperature^ in which is investigated the degree
of heat that man and animals can endure, the author does not ofter
any new results. He notices the well-known effects, such as the ac-
celeration of the pulse, and of respiration, the feeling of greater or
less heat, &c.
The power of maintaining the heat with but slight modifications,
has been long admitted. The experiments of Sir Charles Blagden,
Dr. FoRDYCE, Dr. Franklin, and others, had sufficiently established
it. The greatest elevation was experienced by MM. Delaroche
and Berger in their own persons. The temperature of the former
was raised from 97°. 8 to 106° by staying eight minutes in a stove,
heated to 176° Fahrenheit. Experiments cannot, of course, be in-
stituted on man to ascertain the highest degree his temperature can
attain under the influence of excessive atmospheric heat; but M. Ed-
wards considers, from the general results of experiments on warm-
blooded animals, that he could not, under the influence of excessive
heat, in a dry air, experience during life a higher rise of temperature
than 12°. 5 or 14° Fahrenheit.
The author assigns, with Delaroche and Berger, the agency of
keeping down the temperature of animals, when exposed to heated
air, to the evaporation which takes place from them. This, he thinks
at least, would be sufficient, when the air has a temperature above that
of warm-blooded animals, "but below this limit it would be incor-
rect to attribute to this cause, as is generally done, the real or sup-
posed power of man, and other warm-blooded animals, to maintain
uniformity of temperature under the vicissitudes of seasons, and cli-
mates." p. 201.
On investigating the refrigeration or cooling in different media, at
temperatures inferior to that of the body, M. Edwards found, as a
general result, that the refrigeration was the same in humid as in dry
air, whence it would follow, that the cold, produced by the greater
evaporation in the dry air, was balanced by the cold resulting from
the contact of the humid air. In air at rest, at a temperature inferior to
that of the body, heat is lost in three ways; by evaporation, by con-
tact, and by radiation. If the air be agitated, its radiation will not be
affected; but the constant change of the air considerably increases the
quantity of heat abstracted by contact, and this in a degree proportioned
to the rapidity of the current. Evaporation is also augmented accord-
ing to the velocity of the wind, and it is owing to these circumstances,
that we have often a powerful sensation of cold, when the tempera-
ture may be the same, and the only change in the atmosphere may
have been the greater velocity of its motion.
Edwards on the Influence of Physical Agents on Life. 173
The fifteenth chapter contains novel and ingenious remarks on the
influence of light upon the development of the body. Its influence on in-
organic bodies and on vegetables being undoubted, M. Edwards con-
ceived, that it might not be less manifested on animals. Its effect in
producing those maniacal exacerbations, which occur at the full moon,
and which have been generally ascribed to the direct agency of that
luminary, is unequivocal. The etiolation^ too, or blanching, percep-
tible in the countenances of the miner, and the civic resident, has
been ascribed to its deficiency, but it is obviously difficult in these
cases to distinguish the effect of the privation of light from other
deleterious agencies that abound in such localities. Our author's atten-
tion was therefore directed to the effect of light on the development
of animals; in other words, on those changes of form, which they un-
dergo in the interval between conception and the adult age. He found,
that absence of light manifestly retarded the transformation of the
tadpole into tlie frog, and conversely that its presence favoured the
development of form. His researches on this point led him to the
following interesting and instructive inferences: —
"In the dimates in which nudity is not incompatible with health, the
exposure of the whole surface of the body to light will be very favourable
to the regular conformation of the body. This appHcatlon is confirmed by an
observation of Alexander de Humboldt in his voyage to the equinoctial regions.
Speaking of the Chaymas, he says: * Both men and women are very muscular,
their forms are fleshy and rounded. It is needless to add that I have not seen a
single individual with a natural deformity. I can say the same of many thou-
sands of Carlbs, Muyscas, and Mexican and Peruvian Indians, which we have
observed during five years. Deformities and deviations are exceedingly rare in
certain races of men, especially those which have the skin strongly coloured.'
** On the other hand we must also conclude that the want of sufficient light
must constitute one of the external causes which produce these deviations of form
in children affected with scrofula, which conclusion is supported by the obser-
vation that this disease is most prevalent In poor children living In confined and
dark streets. We may from the same principle Infer that In cases where these
deformities do not appear incurable, exposure to the sun. In the open air, is
one of the means tending to restore a good conformation. It is true that the
light which falls upon our clothes, acts only by the heat which it occasions, but
the exposed parts receive the pecufiar influence of the light. Among these
parts, we must certainly regard the eyes as not merely designed to enable us
"to perceive colour, form and size. Their exquisite sensibility to light must ren-
der them pecufiarly adapted to transmit the influence of this agent throughout
the system, and we know that the impression, of even a moderate light, upon
these organs produces, in several acute diseases, a general exacerbation of
symptoms." p. 111.
The last chapter but one in the book is on the Mteratlons in the
15*
174 Edwards on the Influence of Physical *^gents on Life.
Air from Bespiration, On many topics, connected with this subject,
much discordance has prevailed amongst observers. All, however,
have remarked, that oxygen disappears, and carbonic acid is formed,
but no agreement exists as to the mode in which these results are
produced.
Two chief chemical hypotheses have been formed for this purpose.
The one — that of Black, Priestley, Lavoisier, and Crawford —
that the oxygen of the inspired air attracts carbon from the venous
blood, and that the carbonic acid is generated by their union. The
other, which has been supported by Lagrange, Hassenfratz, and
others, that the carbonic acid is generated in the course of the circu-
lation, and is given off from the venous blood in the lungs, whilst oxy-
gen gas is absorbed.
The first section of the chapter in the work of M. Edwards is
dedicated to an inquiry into the proportion of the oxygen that dis-
appears to the carbonic acid produced. In Priestley's experi-
ments, the latter seemed to have the preponderance. Menzies,
Crawford, Allen and Pepys, Dalton, Prout, Henry, and others,
thought they were equal j Lavoisier and Seguin estimated the oxy-
gen, consumed^in the twenty-four hours, to be 15661.66 grains;
whilst the oxygen, required for the formation of the carbonic acid ex-
haled, was no more than 12924 grains; and Sir Humphry Davy
found the oxygen consumed in the same time to be 15337 grains;
whilst the carbonic acid produced was 17811.36 grains; which would
contain 12824.18 grains of oxygen.
The experiments of Edwards show, that the discordance has not
depended so much upon the different methods and skill of the expe-
rimenters, as upon other causes. He found, on comparing the results
of individual experiments, a great difference in the proportion of the
oxygen absorbed to the carbonic acid produced, ranging between
rather less than a half, and one-sixth, but the quantity of carbonic
acid produced was very uniform, when the circumstances were simi-
lar. He found also, that the variation depends upon the particular
animal species subjected to experiment; upon its age, or on some pe-
culiarity of constitution, and that it differs greatly in the same indi-
vidual at different times.
The disagreement of experimenters, regarding the exhalation or
non-exhalation of azote from the air, during respiration, is even greater
than in the case of oxygen. Priestley, Davy, Humboldt, Cuvier,
Thomson, and others, found a less quantity exhaled than was in-
spired. Spallanzani, Lavoisier and Seguin, Vauquelin, Allen
and Pepys, Ellis, and Dalton, inferred, that neither absorption nor
Edwards on the Influence of Physical Agents on Life, 1 75
exhalation takes place, — the quantity of that gas undergoing no change
during respiration; whilst Jurine, Nysten, Berthollet, and Du-
LONG and Despretz found an increase in the bulk of the azote. The
inferences of our author are, that in a large number of cases the azote
inspired and expired so nearly approaches to equality, that the slight
difference may be disregarded, and exhalation rejected; and, that in
a great number of other cases, the excess of azote is so considerable,
that the exhalation of this gas cannot be denied, inasmuch as the quan-
tity greatly exceeds the volume of the lungs, and bears a large pro-
portion to that of the animal. The causes of these variations ap-
pear to be numerous, and ascertainable with difficulty.
The experiments of M. Edwards with regard to the exhalation of
carbonic acid, ready formed, from the lungs, are very decisive. Spal-
lanzani had affirmed, that when certain of the lower animals, as snails,
are confined in gases that contain no oxygen, the production of car-
bonic acid is uninterrupted. On the strength of this assertion, our
author confined frogs in pure hydrogen for a length of time. The re-
sult indicated that carbonic acid was produced, and in such quantity as
to show, that it could not have been derived from the residual air in
the lungs, as it was in some cases equal to the volume of the animal.
Indeed, it occasionally amounted to five or six per cent. — considerably
exceeding the bulk of the animal. The absorption of a considerable
portion of hydrogen was also noticed.
The experiments were repeated on fishes, snails, and on kittens
two or three days old, with similar results.
With respect to the source of the carbonic acid, M. Edwards con-
cludes, that both in hydrogen and in atmospheric air, the carbonic
acid is owing to exhalation, and that it proceeds wholly or in part
from the blood, which has been proved to contain carbonic acid by
Vauquelin, Vogel, Brande, Sir Everard Home, and others.
When blood is placed in hydrogen, it exhales carbonic acid.
The following general views of the alterations effected in the air
by respiration is given by the author; —
" The oxygen which disappears in the respiration of atmospheric air is wholly
absorbed. It is afterwards conveyed, wholly or in part, into the current of cir-
culation.
" It is replaced by exhaled carbonic acid, which proceeds wholly, or in part,
from that which is contained in the mass of the blood.
** An animal breathing atmospheric air also absorbs azote? this is likewise con-
veyed wholly, or in part, into the mass of the blood.
" The absorbed azote is replaced by exhaled azote, which proceeds wholly,
or in part from the blood.
** Here are four fundamental points:
176 Edwards on the Influence of Physical ^^gents on Life.
« 1st. The absorption of ox3^gen which disappears.
" 2d. The exhalation of carbonic acid which is expired.
"3d. The absorption of azote.
<'4th. The exhalation of azote.
« The two first relate to the oxygen, the two others to the azote.
*« According to this view, respiration is not a purely chemical process, a sim-
ple combustion in the lungs, in which the oxygen of the inspired air unites
with the carbon of the blood, to form carbonic acid, to be expelled; but a function
composed of several acts. On the one hand there are absorption and exhalation,
attributes of all living beings? on the other the intervention of the two consti-
tuents of atmospheric air, oxygen and azote.
" This view is not a preconceived idea, but a result to which we have been
necessarily led by a multitude of facts.
" It exhibits to us animated beings drawing from the composition of the at-
mosphere two of their constituent principles.
<' It furnishes us with numerous inferences, several of which are supported by
facts already received in science.
" Thus the oxygen which disappears being absorbed, and the carbonic acid
exhaled the relative proportions are necessarily variable, from the nature of
the two functions which must vary in the extent of their action. The fact is
beyond doubt. They may vary in three ways. 1. The carbonic acid may be
expired in smaller quantity than the oxygen which disappears; 2, in equal quan-
titv 3 Iw excess. The first Is the ordinary case; the second is supported by the
experiments of Allen andPepys; the third, if it is not yet estabhshed, will pro-
bably be so hereafter. I might even say that it is so already, when we revert
to the experiment of Allen and Pepys, relative to respiration in factitious air,
composed of oxygen and hydrogen. The same observation applies to azote
absorbed and exhaled.
«' Let us return to the oxygen, and consider what becomes of it in the system.
AVhen it is absorbed and carried into the blood, there is every reason to believe,
that it contributes to the formation of carbonic acid. But the experiments
which I have already detailed prove, that it cannot be the only source of the
eas contained in the blood.
" Since we have shown, that certain species of animals can exhale in a given
time, as much carbonic acid in hydrogen, as in atmospheric air, there must be
e or more subsidiary sources for the carbonic acid contained in the blood. It is
asvto point out one. We know, from the researches of Jurine,Chevreul, Magen-
V and others, that this gas exists in almost the whole extent of the alimentary
' 1 We cannot but admit, that it is formed in the process of digestion. It
• in contact with almost the whole mucous surface of the alimentary canal, and
part must be absorbed. If any doubt of this were entertained, cases might be
•f d in which water impregnated with carbonic acid, and drunk in sufficient
^ uantlty has produced symptoms of asphyxia. Doctor Desportes has communi-
cated observations on this subject to the Royal Academy of Medicine.
«' With respect to the oxygen which is to contribute to the formation of the
carbonic acid contained in the mass of the blood, one of two things must hap-
:,en It enters into combination either suddenly or slowly. In the latter case
there will be oxygen in excess, circulating in the mass of the blood. This pure
Edwards on the Influence of Physical Agents on Life, 177
oxygen will therefore be subject to exhalation, which will take place in the
organs adapted for giving* passage to it, as happens in fishes, in the air blad-
ders of which animals oxygen is found. I propose following up this subject,
and examining different kinds of blood, in conjunction with M. Dumas." p. 244.
Not the least important portion of Dr. Edwards's work is the con-
cluding chapter, relative to the applications of the deductions arrived
at from the experiments detailed in the previous chapters; and the
first he makes regards the faculty of producing heat. This faculty-
was shown to vary during health, and it varies still more in a state
of disease.
The phenomena presented by torpid animals, and by the mammalia,
and birds that are not torpid, leads Dr. Edwards to infer, that during
the state of 7iatural sleep there is a diminution in the power of pro-
ducing heat; so that the application of cold, a damp and cold air, or
a dry and piercing wind, which could be borne with impunity in the
waking state, may act most injuriously during sleep.
The natural sleep of hybernating animals, he thinks, merits the de-
nomination of lethargic sleep, from the remarkable diminution of tem-
perature, respiration, and circulation, as well as of the external mo-
tions, and excitability of the senses, but similar changes he conceives
may take place in man, so as to render his sleep lethargic, and he is
disposed to believe in the instances of this kind of lethargic sleep,
detailed in medical works, — affirms, indeed, that his own experience
has convinced him that such cases do occur. We wish M. Edwards
had detailed the cases. The instances of trance, lethargy, &c. of
which there are so many on record, have certainly appeared to us
sufficiently marvellous, and it would take all the weight of M. Ed-
wards's facts and authority to alter our opinions upon the subject. At
one time, it was universally believed, that substances could be admi-
nistered, which might arrest the whole of the vital functions, or cause
them to go on so obscurely as to escape detection, a notion which is
embraced by Shakespeare, in his Borneo and Juliet: —
"Take then this phial.
And this distilled liquor drink thou off;
When presently through all thy veins shall run
A cold and drowsy humour, which shall seize
Each vital spirit, for no pulse shall keep
His natural progress, but surcease to beat.
No warmth, no breath shall testify thou livest,
The roses in thy lips, and cheeks shall fade
To paly ashes; the eyes windows fall
Like death, when he shuts up the day of life;
And in this borrow'd likeness of shrunk deaths
Thou shalt continue two-and-forty hours,
And then awake as from a pleasant sleep. *^
1 78 Edwards on the Influence of Physical Agents on Life.
No one, however, at the present daj, believes in the existence of
any such medicament.
2. In his second '-application," he assimilates the effect produced
upon young animals by refrigeration, to the defective power of pro-
ducing heat in the fehres intermittentes algidae^ described by Torti,
in which the power is so far impaired, that the patient dies in the
cold stage, at the end of two or three paroxysms, if suitable remedies
be not employed.
"3. Since the application of external heat tends to reanimate the power of
producing it, this means may be substituted for the extraordinary efforts of the
system, which tend to the same object. It may be done either to prevent them,
or to shorten their duration."
4. From the experiments, connected with dry and moist air, he
considers, that damp cold must tend to produce, in individuals whose
power of developing heat is rather feeble, the series of actions which
constitute the accession of an intermittent fever, especially if they
are exposed to that influence during sleep. Such a state of the at-
mosphere is, indeed, a great exciting cause of intermittents, provided
a predisposition exists, derived from a malarious locality, but without
this predisposition, the exciting cause might be applied in vain. In
many parts of every country intermittents are unknown, notwith-
standing the prevalence of winds of the character described.
5. Dr. Edwards transfers his results, connected with the influence
of the seasons on the production of heat, to the question of the in-
fluence of climates, and as the animals, in his experiments, appeared
to exhibit a summer and a winter constitution, he compares the for-
mer with that of the inhabitants of warm climates, and the latter
with that of the inhabitants of cold climatesj "but there will be this
difference, that the modification which characterizes the summer con-
stitution in our climate, will be much more strongly marked in warm
climates."
Now, in individuals whose constitution is suited to the climate,
there is a diminution of the power of producing heat in summer, and
an increase in this respect in winter, whence he concludes, that this
power will be feebler in the inhabitants of warm, than in those of
cold climates, and consequently, when they change their climate,
they must be, in general, less capable of supporting the cold, than
the natives of the country.
6. In warm climates, a remedy is found for the excessive heat, in
the increased evaporation which takes place, but its influence is con-
sidered to be exaggerated, when it is supposed that an exact compen-
sation can be effected by it.
f. Does the temperature of man and of warm-blooded animals
Edwards on the Influence of Physical Agents on Life, 1 79
vary according to the season? The general belief has been, that it
is constant in the state of health and in ordinary circumstances, not-
withstanding the heats of summer and the colds of winter. From
several experiments, however, tried by our author on yellow-hammers
and sparrows, at different periods in the course of the year, it would
result, that the averages of their temperature ranged progressively from
the depth of winter to the height of summer, within the limits of 5°
or 6° Fahrenheit: and the contrary course was observed in the decline
of the year. Hence he infers, and with every reason in his favour,
that the temperature of man experiences a similar fluctuation.
8. The human temperature is rarely raised beyond 106° Fahren-
heit, in the hottest of all diseases, scarlatina. Dr. James Gregory,
of Edinburgh, used to assert, that he doubted the accuracy of
the thermometer when a higher temperature was indicated. M. Ed-
wards alludes to a case of tetanus, communicated to him by M. Pre-
vosT, of Geneva, in which the temperature rose to 110°. 75 Fahren-
heit; so that if the healthy temperature of the child was 98°. 2, here
was a rise of 12^°, Fahrenheit.
9. To reduce this excessive heat, external agents of a suitable tem-
perature are most effectual: damp cold, of all external means of re-
frigeration, tends best to diminish the activity with which heat is de-
veloped. Hence its value as a refrigerant in fevers, now universally
acknowledged.
10. But if damp cold cannot be sufficiently prolonged, spongino-
with water of any temperature, provided it be not excessively hot,
occasions a more abundant evaporation, and a salutary refrigeration,
the effect of which is extended to other parts of the frame, by virtue
of the extensive sympathy that exists between all parts of the capil-
lary surface.
11. When the ventilation of an apartment is properly attended to,
the quantity of heat is diminished, both by the contact of fresh por-
tions of air, and by increased evaporation,
12. Excessive evaporation is injurious to man. The distress, ex-
perienced in the higher regions of the atmosphere — on the tops of
mountains, or in balloons — is rather owing to this cause, perhaps,
than to the rarefaction of the air, although the latter has its effects.
In the celebrated aerial voyage of Gay Lussac, he found that the air
contained, at the height of 23,000 h^i, only one-eighth of the mois-
ture necessary for its saturation. Owing to this cause, such an in-
crease of evaporation takes place from the dermoid surface, under
these circumstances, that the loss of fluid occasions a sensation of dis-
tress in the chest, proportionate to the desiccation.
180 Edwards on the Influence of Physical t^gents on Life.
" If, as frequently happens upon mountains, the weather change quickly,
loading the air with humidity, the evaporation becomes moderate and the distress
diminishes, or ceases entirely. If it still continue it is owing to the rarefac-
tion of the air. The effect of evaporation is felt the first, and that which is
owing to a want of air comes long after j it requires even a much greater height
to produce it than one would be inclined to believe when the two sensations are
confounded.
" Thirst is a symptom which attends the ascent of mountains. It is some-
times intense, when it cannot be ascribed to the fatigue of exercise. It is only
momentarily satisfied, even by abundant and often repeated draughts. But if
the air becomes charged with moisture, the thirst at the same time disappears.
Here is an example perfectly analagous to that which we have elsewhere men-
tioned as the effect of a partial desiccation, although the body may be fur-
nished with a sufficient quantity of water to prevent its losing its total weight,
the distribution of the liquid to the different part not being in sufficient pro-
portion to repair local loss. It is obvious that this influence will be very dif-
ferently felt by different individuals, according to the state of the lungs."
p. 260.
13. Dr. Edwards alludes to a symptom, connected with respiration
limited bj rarefaction of the air, which has not been usually noticed —
a disposition to vomit. This has been observed during the ascent of
great heights, and the author thinks the symptom, thus induced, may
be connected with a great many others, in which respiration is limit-
ed in various ways, as in acute or chronic congestion of the lungs,
*' when the disposition to vomiting, and vomiting itself, are frequently
symptoms arising from the diminution of the communication of the
system with the air."
14. Species and individuals vary greatly in their power of sup-
porting limited respiration. It would not seem, that the limits, at
which extreme rarefaction produces effects almost as rapid as those
of the absolute privation of this fluid, differ greatly in warm-blooded
animals. The pressure at which yellow-hammers were on the point
of dying, corresponded, taking the average, to 5.31 inches of the ba-
rometer; the average for Guinea pigs, to 3.58 inches; and these ani-
mals presented the extreme results.
15. Facts, connected with excessive evaporation from the lungs,
are observed in other than elevated regions. When, during a very
sharp cold in winter, a room is warmed by means of a stove, a pain-
ful sensation in the chest is experienced by many. The air, in a frost,
contains scarcely any watery vapour, and the heat of the stove, by
raising the temperature of the air, increases its capacity for vapour,
so that, at an equal temperature, the quantity of liquid dissipated by
evaporation is much greater than in summer. To remedy this, in some
Edwards on the Influence of PhysicalJl gents on Life, 181
measure, we are in the habit of placing a vessel of water upon the
stove, and it is advantageous.
"In arid districts," says M. Edwards, " effects are ascribed to the heat of the
ah" and of the wind, which arise, in a great degree, from the evaporation occa-
sioned by the dryness of the atmosphere. Dr. Knox, who travelled in the in-
terior of Africa, to the north of the Cape of Good Hope, has related to me facts,
which justify this opinion." p. 263.
16. In an agitated atmosphere, not extremely humid, evaporation,
as a general ruie, may be as great as in a calm and dry air; but if
we suppose two states of the atmosphere in which the effects of mo-
tion in the one would equal those of dryness in the other, their respec-
tive influence upon evaporation would not be the same.
" Air in motion only acts upon exposed surfaces, as the integuments of the
body; those of the lungs are sheltered, and notwithstanding their communica-
tion with the atmosphere, the agitation of the air has but a slight share in the
quantity of vapour which they furnish. This consideration will serve to deter-
mine the choice of suitable places for the residence of delicate persons. Those
to whom the increase of evaporation from the lungs is injurious, ought to pre-
fer an atmosphere less dry, but slightly agitated, when it is important to obtain
an agreeable freshness." p. 264.
17. To remedy the dryness of the skin, and air passages, which,
acts most prejudicially, in the opinion of the author, in a great num-
ber of acute diseases, and for which drinking is insufficient, the atmos^
phere ought to be rendered moist by a sufficient evaporation of water,
by which means the desiccation of the respiratory organs may be ar^
rested .
18. The author properly inculcates the necessity of guarding chil-
dren against the injurious impressions of cold in cold climates and
seasons, by appropriate clothing, and he ascribes much mischief to a
neglect of these precautions. Although the want of warm clothing
is actually felt, its use is often declined from a wish to reserve it for
an advanced age; but our author thinks it frequently happens, that
this very precaution is the cause of preventing that age from being
attained.
19. Clothing is insufficient to preserve the heat so as to maintain
the existence of very young animals, and of infants born about the
period when they begin to be viable or rearable. The continued ex^
ternal application of heat is demanded, until the body has acquired
sufficient development; and the same remarks are applicable to every
period of life, when the constitution, from any cause, approximates
to the modification in question.
20. This '* application^'^ treats specially of the effects attributed to
Na. XXVII.— May, 1834. 16
182 Edwards on the Influence of Physical Jlgents on Life.
suppression of perspiration, of which we have already expressed our
opinion.
21. If we compare the daily average of meats and drinks, during
the course of a year, with the sum of all the losses by perspiration,
and the alvine and urinary evacuations, it will be found that they are
nearly the same. On taking the average results of observers, it is
found that the proportion of urine to perspiration is, on the whole,
about 1 to 1.08. The alvine evacuation forms but a small portion of
the total loss, the mean of all the tables being four ounces.
** By subtracting' this quantity from the sum of the meats and drinks, and
taking the half of the remainder, we shall have an approximate result of the
mean product of the perspiration of a day in the course of the year. In order
to judge of the degree of approximation which may be attained, by making
use of these data with the mere knowledge of the sum of meats and drinks,
we give the comparison of the results furnished by experience, with those de-
duced by calculation from the preceding proportions.
«* Mean Losses hy Perspiration in a Day.
Robinson. Robinson. Keill. Rye. Lining.
42 yrs. 64.5 yrs. 39 yrs. 42 yrs. 40 yrs.
By observation, 45 oz. 27 oz. 30 oz. 56 oz. 60 oz.
By calculation, 41 27 35 46 62
It is found, that in temperate climes the mean perspiration in
summer exceeds the urine; whilst in winter the contrary holds good.
In warm climates the average of perspiration for the year doubtless
exceeds the average of the urine.
22. M. Edwards lays great stress upon the eft'ect of slight agita-
tion of the air, when the hygrometric state and temperature are adapt-
ed to the system: the chest, under such circumstances, dilates, and
admits a large proportion of air; and he thinks that persons who have
what is called delicate lungs, may owe in a great degree the difficulty
and oppression which they feel to the small ness of their apartments;
as the difficulty decreases on going into a large room, or into the open
air; and he affirms, that whatever difference of purity may be attri-
buted to the air of small and of large towns, of narrow and of wide
streets, of town and of country, the degree of agitation of the air
has the most marked influence on the extent to which the chest di-
lates; and the agreeable sensation, which is experienced on breathing
in the country is principally due, he conceives, to that cause.
24. As young animals bear a limited respiration better than adults,
he infers, that children, in whom respiration may be limited by en-
gorgement of the lungs, will, cseteris paribus, be in less danger than
adults, in whom respiration may be limited in like manner, and to
Edwards on the Influence of Physical Agents on Life. 183
the same degree, and as the disturbance of the system, indicated by
the acceleration of respiration, circulation, &c. is so much the greater
as the want of air is the more pressing, the symptoms of pneumonia
will be more intense in adults, in cases in which the relative extent
of disease is equally limited.
25. If, therefore, an individual be affected with pneumonia, so far
as to endanger his life by diminished communication with the air, the
most urgent indication will be to employ the best means for bring-
ing back his constitution to that state which would enable him to
support his limited respiration. For this purpose, blood enough must
be abstracted to diminish the power of producing heat, and keep it
within the limits compatible with life. The more serious the case,
the greater ought to be the abstraction of blood. Such is the author's
theory. We would inculcate the same practice, under the obvious
indication that the inflammation must be got under, otherwise it will
run on to disorganization and death.
Some other applications are given by M. Edwards, but they are
mostly speculative, and not as pregnant with interest or novelty as
those we have considered.
The following remarks in his concluding application are, however,
important.
** We find in the chang-es which the blood can undergo as to its composition,
a fertile source of the chang-es in the mode of vitahty. It would appear at first
that it is only through this medium that we can act on the nervous system, in
order to modify its action so as to change the constitution of individuals; on ac-
count of the extent in which this fluid can vary, and of the apparent immutabi-
lity of the nervous system in its form and structure.
*' It is evident, that the dimensions and proportions of that system have limits
assigned by nature to the modifications which their vitality can undergo; it is,
however, susceptible of considerable changes, not discernible by inspection,
but which manifest themselves by the actions which result from them, and
which do not arise from the influence of the blood. Such effects may, as we have
formerly proved, be produced by temperature, by light, electricity, and a number
of other influences by contact to say nothing of moral causes. It is this which
I have had in view in speaking of the special action of the air on the system,
and which I have designated vivifying influence.
** It is thus that the impression of the air serves to reanimate a life almost ex-
tinguished in the case of apparent death, and here man has an advantage over
all warm-blooded animals, even the hybernating. Their skin, covered with hair
or feathers, is less accessible to the air; and I have never seen an adult individual
which, after the cessation of all external motion by submersion in water, has
been recalled to life by exposure to the air. Man, on the contrary, whose skin
is bare, delicate, and sensible, may be reanimated by the action of the air,
when he appears to have lost, under water, sense and motion.
" We have shown elsewhere, that new-born children, when deprived of air,
would not give signs of life during so long a space of time as young" mammalia
1S4 Edwards on the Influence of Physical t^gents on Life.
of the same age, which are born with closed eyes; they will, however, more
easily recover from apparent death, because their skin is adapted to receive a
stronger impression from the air.
" We have seen how fatal heat is in cases of asphyxia, and of very confined
respiration. Now, when the action of the air is reduced to the effects which it
produces upon contact with the skin, its influence is the weakest possible, and
at first it cannot easily be conceived what advantage can be derived from the
application of heat. If that application be of long duration it will be fatal; in
some cases it may be useful if it is of short duration. When an animal is plunged
in water at the temperature of 40° cent, or 104° Fahr., its motions are much
more forcible, but less numerous than at inferior temperatures. There are cir-
cumstances, then, in which heat may be momentarily applied in order to excite
the movements of the chest. The immersion of a great part of the body in warm
water, is frequently an efficacious means of reanimating a child just born with-
out signs of life. As soon as motion is produced, or if it be slow in manifesting
itself, it will be right to abandon a method, the prolonged use of which, would
be fatal.
** We must, therefore, look upon the vivifying influence of the air in two
points of view, its direct action on the nervous system by contact; and its action
on the blood by the changes which it produces in it. In like manner, the vi-
tality of individuals may be modified by a number of other causes which act im-
mediately, either on the nervous system, or on the blood. Many facts mentioned
in this work, are examples of both modes of action."
We have thus endeavoured to lay before the reader a full and clear
analysis of the topics embraced in the original work of Dr. Edwards,
as well as in the version before us. No one can witness the labour
and research bestowed by the author without being impressed with
his preeminent qualifications as an experimental physiologist, and
without according with the encomiastic remarks of Dr. Hodgkin,
" Some minds,** he observes, " are so happily constituted as to have a remarka-
ble readiness in perceiving the relations which connect facts and observations,
which to others appear not merely isolated, but absolutely contradictory. This ap-
pears to be particularly the case with Dr. Edwards. The labours of his predecessors
had accumulated avast collection of invaluable facts and observations, many of
which seemed to be almost annihilated by their standing in direct opposition to
others supported by equally valid and respectable authority: the labours of Dr.
Edwards have explained many of these discrepancies. It may be ill-becoming
in me to anticipate the judgment of the reader, but I cannot refrain from ex-
pressing my admiration of the patient and clear induction with which the doctor
proceeds, step by step, through the great variety of subjects comprised in his
work, so as to maintain the unity and connexion of the whole, and of the happy
art with which he has both availed himself of the experiments and observations
of his predecessors, and supplied the breaks and deficiencies which he met
with, by well-contrived, simple, and conclusive experiments of his own.*' Pre-
face, p. V.
The appendix to the work by the translators, consists of various
papers by Dr. Hodgkin and other individuals. The first is on EJec-
Edwards on the Influence of Physical Agents on Life. 185
tricity, by MM. Prevost and Dumas, and comprises a detailed account
of their views regarding muscular contraction, which were briefly ex-
plained in a late number of this Journal.* The second is by Dr. Ed-
wards, and is ''On Muscular Contractions produced by bringirig a
Solid Body into contact with a Nerve without a Galvanic Circuit.''^
It has been long known, that when nerves and muscles are exposed
in a living animal, and brought into contact, contractions or convul-
sions occur in the muscles. The experiments of Galvani, Volta,
Aldini, Pfaff, Humboldt, and others, had satisfactorily established
this. In the experiments of M. Edwards, the same effect was pro-
duced by touching a denuded nerve with a slender rod of silver, cop-
per, zinc, lead, iron, gold, tin, or platina, and drawing it along the
nerve for a space of from a quarter to a third of an inch. He took
care to employ the metals of the greatest purity, and as they were sup-
plied to him by the assayers of the mint. But it was not even neces-
sary that the rod should be metallic, he succeeded with glass or horn.
"To produce muscular contraction it is sufficient that the nerve be
touched with any solid body in the manner above related." All
these metals, however, did not produce equally vigorous contractions.
Iron and zinc were far less effective than the others, but no accurate
scale could be made of their respective powers.
Much difference is found to exist when electricity is employed, ac-
cording as the nerve is insulated or not, for as the muscular fibre is a
good conductor of electricity, if the nerve be not insulated, the elec-
tricity is communicated to both nerve and muscle, and its effect is
consequently diminished. It became interesting to know, whether
any difference would be produced, when one metal only is used, if
the nerve be insulated or not. In the experiments, above referred to,
the nerve was insulated by passing a strip of oiled silk beneath it. A
comparison was now made between an animal so prepared, and an-
other in which the nerves, instead of being insulated, reposed on the
subjacent flesh.
" I made use/' says M. Edwards, "of small rods, with which I easily excited
contractions, when I drew them from above to below, along* the portion of de-
nuded nerve, which was supported by the oiled silk; but I was unable to excite
them, when I passed them along the nerve of the other animal, in which they
were not insulated. Frequent repetitions assured me, that the want of effect did
not depend on difference in the degree of contact: I tried the experiment on
many animals of the same species,, lest there might be any thing" in individual pe-
culiarity. As in the one case the nerves were brought further into view, and kept
somewhat tense and even with the sacrum, by means of the slip of oiled silkj,
* Number XXIII. for May, 1833, p. 144.
16*
186 Edwards on the Influence of Physical Jigents on Life.
whilst in the other they had no such support, I restored the parity of position,
by placing- under the unsupported nerves, a portion of muscle, corresponding
to the slip of oiled silk, as well in size as mode of insertion, and still was un-
able to produce contractions by treating the uninsulated nerve, whatever was
the material of the rod employed as the exciter. The difference was rendered
still more striking-, when instead of making- the comparison between two in-
dividuals, it was made upon the same animal. After having- in vain attempted
to produce contractions by contact of a nerve resting upon muscle, I found
that they might still be induced, if the oiled silk were had recourse to, and I
was able to command their alternate appearance and disappearance, by using-
sometimes a non-conductor, and at others, a conductor for the support of the
nerve." p. 313.
Somewhat surprised at these results, our author was stimulated to
the investigation — whether some degree of contraction might not be
excited by touching the uninsulated nerve? and, having observed, that
in the insulated nerve contractions were most constantly produced
by a quick and light touch, he adopted this method in an animal
whose nerve was not insulated, and frequently obtained slight con-
tractions.
All his experiments on this matter seemed to prove satisfactorily,
that, cxieris paribus, the muscular contractions produced by the con-
tact of a solid body with a nerve, are much less considerable, or
even wholly wanting, when the nerve in place of being insulated, is
in communication with a good conductor; " and it would seem to fol-
low, as a legitimate conclusion, that these contractions are dependent
on electricity;" facts, which it is highly necessary to bear in mind,
in all experiments on animals, where feeble electrical influences are
employed.
On the remaining selected articles we cannot dwell. The length
to which this review has already extended, precludes us. We may
merely remark, that in the article on atmospheric electricity, by
Pouillet, the author ascribes its origin greatly to the changes effect-
ed during vegetation, and to the evaporation from the surface of the
sea, which forms, in his opinion, one of the most important sources.
Signs of electricity are produced by evaporation from an alkaline so-
lution, but not from mere evaporation, whether rapid or slow. Lakes
and rivers are, however, presumed to have their influence, since their
waters are never perfectly pure, but contain alkaline impregnations.
The remaining papers consist of an extract from an Essay on some
of the Phenomena of Atmospheric Plectricify, by Luke Howard,
F. R. S., which was published thirty-four years ago, with remarks
on the same subject by the editor, (Dr. Hodgkin,) and experiments
and observations by C. Woodward and P. Smith: Dr. Hodgkin's
Inaugural Essay — De Absorbendi Functione — a fair specimen of sucli
Edwards on the Influence of Physical Agents on Life, 187
essays, but not worthy perhaps of republication, in the same form,
at least; with further remarks on the same subject, by the author:
Onthe Phenomena to wMchthe names Endosmo sis and Exosmosis have
h^en given by Dutrochet: On the Microscopic Characters of some of the
Animal Fluids and Tissues, by J. J. Lister and Dr. Hodgkin; and
lastly a <' juvenile essay," by Dr. Hodgkin, on the Uses of the Spleen,
published in the Edinburgh Medical and Surgical Journal, January,
1822; in which he regards, with others, the spleen as a diverticulum,
and as fulfilling an office in the animal system, similar to that of
tubes and valves of safety, in various kinds of chemical and me-
chanical apparatuses.
Many of these subjects have been noticed in the pages of this
journal, and although the author's sentiments are manifestly regard-
ed by him to be full of important bearings, we have strong doubts
whether the physiological world will think them equally so. His
microscopical researches have certainly destroyed the idea of the
beautiful harmony and simplicity, that appeared to prevail in or-
ganized existence, from the microscopic researches of Dr. Milne
Edwards, who found, that "spherical corpuscles, of the diameter of
y-i-Q-th of a millimeter, constitute by their aggregation, all the organic
textures, whatever may be the properties, in other respects, of those
parts, and the functions for which they are destined."
Under this view of Dr. Edwards, it followed, of necessity, that all
organized bodies possess the same elementary structure, and that the
animal and the vegetable are readily convertible into each other,
under favourable circumstances, and differ only in the greater or less
complexity of their organization. The globular tissue is asserted by
Dr. Hodgkin to be a mere illusion, and we have again to refer the
most minute parts of the cellular membrane, muscles and nerves, to
the striated or fibrous arrangement.
In the notes, p. 483, we have the old claim of Dr. SxEVENs—that
he suggested to Drs. Faust and Mitchell their important experi-
ments on the penetrativeness of gases, vindicated by Dr. Hodgkin;
but on this we have already expressed our sentiments.*
With respect to the execution of the translation it is but moderate.
Due attention has not been paid to the correction of the proofs; the
verbal mistakes are numerous, and throughout the first portion of the
work, the thermometric calculations are given in degrees and minutes;
33° 8' for example, being written for 33°. 8. Especial care should
have been paid to prevent such mistakes, in a work whose great value
is its accurate experimental details and estimates. R. D.
* American Journal of the Medical Sciences, for May, 1833, p. 201«
( ISS
BIBLIOGRAPHICAL NOTICES.
XV. A New Exposition of the Functions of the Nerves. By James William
Eahle. Part I. Longman, Rees, & Co. 1833.
The author of the volume before us, very truly remarks, that when we con-
sider the many and almost insurmountable difficulties which present themselves
to the physiologist in inquiring into the hidden functions of the nervous sys-
tem— the various sources of error and perplexity ever occurring to the inquirer
from injury to its functions by the very means employed to examine into them —
how essential it is to the existence of animals, and how little light the mere
knowledge of the anatomical structure and disposition of the brain and nerves,
has thrown upon the mode in which they operate in producing the different
phenomena upon which the continuance of life depends, we can neither be
surprised at the opposite conclusions at which some observers have arrived, nor
at the unsatisfactory state of our knowledge up to the present hour.
Mr. Earle thinks, that our acquaintance with diseases of the nervous system
may be considered as nearly parallel with that of our predecessors, with regard
to those of the sanguiferous system before the discovery of the circulation of
the blood. They had some idea of the pulmonary circulation, as we have of the
different functions of the anterior and posterior spinal nerves; —
" Yet we wonder that they could have considered that the small amount of
knowledge which they possessed, could enable them to account for phenomena
of daily occurrence, and our successors, in like manner and with equal justice,
will no doubt be surprised at us."
The author appears to be very confident of the novelty and importance of
the views to which he has been led by his experiments relative to the func-
tions of the nervous system in health and disease ; for he remarks, that if the
discovery of Harvey, admitting of such clear and satisfactory demonstration,
met with violent opponents and a tardy acquiescence, in adducing facts which
are addressed to the eye of reason only, he cannot expect to escape that share
of prejudice and opposition which has always attended the announcement of
novelty; nor that the opinions derived from the facts which he has brought for-
ward will be readily allowed to be just ; for, as it has been well observed by an
old writer, " before truth in its silent and disputed march has roused the atten-
tion of the indolent, converted the supercilious, subdued the interested and ob-
stinate, and reached the ears of all, an age has passed away."
The attention of Mr. E. was more particularly directed to physiology by the
great alarm occasioned by the frequent occurrence of hydrophobia in the spring
and summer of 1830, and by a consideration of the fact, that many diseases re-
main intractable until their nature is understood. It appeared to him that this
was probably the case with hydrophobia — and that we should remain ignorant
of the place to apply our remedies in that disease, as well as of the nature of
those remedies, until we had ascertained the cause of the violent spasmodic ac-
Earle on the Functions of the Nerves. 189
tion of the muscles of the throat and chest. But in order to arrive at the cause
of the improper action of muscles in disease, it was first necessary to under-
stand the cause of their healthy action. This led to the examination of a multi-
tude of experiments bearing upon the subject, and naturally involved the con-
sideration of the laws which regulate the whole of the vital functions.
"But beyond inquiring- into the cause of the healthy action of muscles, it was
necessary to ascertain the nature of the power which enables them to contract
at all; for it is as necessary that muscles should have a power of contraction as
that there should be a power to call them into action, so that it may be useful
for purposes connected with the maintenance and preservation of life."
As may be known to our readers. Dr. Wilson Philip, stated as the results of
his experiments, that the contractility or power of contraction of the voluntary
muscles, is entirely independent of any influence derived from the nervous sys-
tem, as is also that of all involuntary muscles, though these last are at all times
readily influenced through that system. These facts, as he himself admits, seem
to imply a contradiction ; but he agreed with Le Gallois, that two facts well as-
certained, however inconsistent they may seem, do not overturn each other ;
but only prove the imperfection of our knowledge. It occurred to Mr. Earle,
that as it is not common to find any inconsistency in nature, and as a great deal
of evidence is brought forward by Dr. Philip upon a point but little requiring
it — the readiness with which the involuntary muscles are influenced through
the nervous system, the most important question might have been overlooked.
He therefore determined to ascertain whether there actually was any inconsist-
ency, and whether the facts from which such opinions were deduced were un-
objectionable. He remarks, that the experiments of Le Gallois were consider-
ed by a committee of the French Institute as having entirely overturned many
of Haller's opinions, and also as affording a satisfactory explanation of several
facts which no one had ever accomplished before him.
"It has remained for the ingenuity of Dr. Philip to point out certain infer-
ences which are not borne out by the facts adduced by M. Le Gallois. It is, in
like manner, the object of the present investigation to show that many of the
facts brought forward by Dr. Philip do not warrant the inferences he has drawn
from them. As Dr. Philip considers some of his experiments not only confirm
some of the most important of Haller's opinions, but remove all objections
which have ever been made to them, so in refuting the conclusions of Dr. Philip
these objections must be allowed to return in all their force; consequently, the
observation which he makes upon the experiments of Le Gallois," by ascer-
taining some facts of great importance, while others immediately connected
■with them escaped his observation, have left the subject in greater confusion
than he found it " may be apphed with equal justice to his own."
It is to be remarked, that according to Mr. Earle there does not appear to
be any reason to doubt the accuracy of Dr. Philip's experiments — with the ex-
ception of one. It is simply to the inferences deduced from them that he ob-
jects.
Mr. E. affirms, that if the details of Dr. Philip's experiments are read with
due attention, it will be readily perceived that they do not prove, 1st, that the
power of contraction or excitability of the muscles of voluntary motion is de-
pendent on the mechanism of the muscular fibre, and independent of the ner-
vous system; 2d, that the action of the heart and arteries is independent of the
nervous system; 3d, that the nervous power is independent of the brain; 4thj
1.90 Bibliographical Notices.
that the nervous power is identical with galvanism ; and 5th, that the vital prin-
ciple is independent of the brain. These points it is the object of his work to
disprove.
He remarks that Dr. Philip has also fallen into a great mistake in confound-
ing the "nervous power" with volition; and adds, that this mistake leads to
great confusion with regard to what he (Dr. P.) called the sensorial power, of
which he considers vohtion as forming a part. Whether Dr. Philip wishes to
signify by this term the united functions of the whole brain, including the in-
tellectual and moral faculties; or whether he only signifies volition, sensation,
and that influence which secreting surfaces lose when their communication
with this organ is interrupted by the division of their nerves, as three joined in
one ; or whether he means that they are independent of each other, it is, he
thinks, absolutely impossible to discover.
" But whatever meaning Dr. Philip attaches to the term sensorial power, it is
certain that its two most obvious properties, namely, volition and sensation,
bear an opposite relation to each other; the one being an active and the other
a passive property." " Besides this opposite relation, these properties are en-
tirely independent of each other; because volition may be exerted spontane-
ously at any time without any distinct external impression having been previ-
ously conveyed to the brain along the posterior nerves ; nor is the perception
of any such impression of necessity followed by an exercise of volition. On
this account the use of the term sensorial power is highly objectionable, and"
** ought to be discontinued."
Previously to entering upon the examination of the facts from which Dr.
Philip has drawn his inference, Mr. E. points out to what he regards as two im-
portant errors arising from a most unaccountable misconception of well-known
facts, which are of sufficient importance to affect the whole doctrine of irrita-
bility. These errors have reference to the circumstances which cause the life
and death of an acephalous fcsetus; and to the reason why the heart of an
animal continues to beat a short time after the head is cut off.
The phenomenon presented by the birth of a brainless foetus has generally
been referred to, as containing the most positive and convincing evidence, that
the doctrine which teaches that the brain is the cause of all life and motion is
erroneous. Mr. E. thinks, however, that it only requires a little more attention
than has yet been paid to the circumstances attending these monstrous produc-
tions, to show that instead of contradicting, they usually confirm this doctrine.
According to him, in order to investigate this subject properly, the first ques-
tion asked should be, what is the cause of the motion of the first punctum sa-
liens in the embryo. The motion of the red globules of the blood is certainly
an effect of some cause or other; for we cannot imagine them capable of mov-
ing by any inherent property. This cause he feels disposed to refer to the
nervous influence of the mother; because there is neither nerves nor brain in
the embryo, nor, indeed, any thing belonging to the latter which can be the
cause of the motion. If that cause has the power of originating the motion of
the first punctum saliens, so also it must have the power to continue the motion
of the blood until the foetus is fully developed, and ready to be born ; or in
otlier words, capable of taking upon itself the maintenance of an independent
existence.
"For this purpose it is necessary that the young animal should be provided
Earle o?i the Functions of the Nerves. 191
with an apparatus calculated to supply exactly the loss it will sustain upon be-
ing separated from its mother; otherwise it must inevitably die upon being re»
moved from that M'hich had hitherto been the cause of its hfe and growth. Now
the only system which appears at all fitted to answer this purpose is that of the
brain and nerves."
Almost every possible variety of congenital defects has been recorded, and
it is found that the duration of their existence has invariably been proportion-
ate to the approach towards perfection which the brain and spinal marrow had
attained.
" Some in whom there has been a spinal marrow and a stnall portion of brain
have been known to live even for a week. Some, who have had no brain but
a tolerably perfect spinal marrow, have lived a few days; while those who have
had neither brain nor spinal marrow, have never breathed at all."
It is true, that in such monsters the heart, lungs, or ribs are rarely found
perfect; but whether this be so or not — whether such foetuses breathe or not at
birth, is of no consequence to the present question, and does not increase the
difficulty of understanding why they should move immediately after birth ; be-
cause, being at that time only just removed from what had hitherto support-
ed their growth and vitality, they are very nearly in the same condition as an
animal from whose body these parts have been recently severed. Neither is
there, according to Mr. Earle, any difficulty in comprehending why the first
two varieties should occasionally exist a few days or even weeks ; because the
nearer they approach perfection, however distant from it, the better are they
able to support and maintain, for a short time, the vitality which they possess
at the time of birth; but such defective organization being insufficient to an-
swer this purpose eifectually, death must at length inevitably ensue. Where
then, he exclaims, do we find in the circumstances attending the birth and death
of these unhappy objects, any evidence which proves that the brain is not the
source of nervous influence ? Do they not rather offer the strongest possible
proof, that unless there is an apparatus provided which is capable of supplying
the place of that which is lost upon the foetus being separated from the mother,
it must inevitably die ?
In regard to the second subject on which he supposes an important error has
been committed by the supporters of the doctrine of irritability — the continu-
ance of the action of the heart after the decapitation of the animal — Mr. Earle
remarks, that the will during perfect health is always the power which calls the
voluntary muscles into action, and that when the head is cut off, the will being
at the same time removed, the muscles, after a few contractions caused by the
injury to the spinal marrow as the knife passed through it, remain quiescent.
But the case is very different with regard to the heart. Neither the will, nor
any exercise of the intellect has any effect upon the contraction of that organ ;
hence the cause of its action is not removed when the head is cut off, and it
ought not to be expected that the heart should cease to beat immediately upon
removal of that which never had any effect upon it.
" In a few minutes, however, it does cease to beat, and then stimulants so
often fail to excite any farther contractions, that some have denied that it can
be made to contract again. The heart is now said to be exhausted; but is this
the case with the voluntary muscles ? Certainly not; for as the cause of their
action was removed with the head, they have remained at rest; consequently
19^ Bibliographical Notices.
they are not exhausted, and are still capable of contracting when stimulated.
Now, supposing that the nerves of these muscles and the nerves of the heart
each had their proper proportion of influence at the time of the removal of the
head, the nerves of the voluntary muscles and the nerves of the heart would be
in an opposite slate as regarded their nervous influence ; the one would be
plus, the other minus, consequently the voluntary muscles will contract when
stimulated, but the heart will not. When, howeverj the former have been ex-
hausted by having been repeatedly excited to contract, they are then, but not
till then, in the same condition as the latter, and neither can be excited to any
fresh contraction." *' It appears to me impossible to arrive at any other con-
clusion from these observations, than that the reason why the heart continues
to beat a short time after the head of an animal is cut oflT, is because the cause
of its constant motion is not removed by such an injury.'*
Mr. E. next proceeds to state the grounds upon which he considers himself
justified in believing, that a something, which has been called nervous influ-
ence, is constantly emanating from the brain. As there are many who deny the
existence of any fluid which comes from the brain and passes along the nerves,
on account of its being invisible, the author thinks it necessary to refer to the
phenomena observed in certain fishes. Some species of these are observed to
have the power of generating, within their bodies, a subtile fluid, which for
want of a better term has been called animal electricity, although the points
of diflTerence between it and chemical electricity are more remarkable than
their points of analogy. Mr. Hunter long ago pointed out to the magnitude
and number of the nerves bestowed on the electric organs, in proportion to
their size, and thought it highly probable that they were subservient to the
formation, collection, and management of the electrive fluid.
" When one of these fishes," says Mr, E. " has been much irritated the
shocks which it gives gradually become so feeble as to be scarcely percepti-
ble; but if he is allowed to remain quiet for a few hours, he is again capable
of giving a very powerful shock. This fact proves that there is within the ani-
mal an apparatus capable of reproducing the electricity when it has been ex-
hausted. It is impossible to suppose it can be restored by rest alone, for how*
ever long the animal might remain quiet, it would still be precisely in statu quo,
unless some positive action had gone on during rest. Neithef can it be imagin-
ed to have been reproduced by any action of the nerves themselves, because it
cannot be supposed that this would have happenedif their communication with
the brain had been^ut off by their division; but there is no difficulty whatever
in attributing the reproduction of this fluid to an action of the brain, by means
of which it may be gradually collected in the nerves ; because such an opinion
is in perfect accordance with so many well-established facts, which prove that
the functions of the nerves are always affected in proportion to any extent of
injury which may be committed upon the brain, and if formed by the brain it
can arrive at the electric organs by no other conductors than the nerves be-
longing to them."
From these facts, as well as from the similarity of appearance of gases having
widely different properties, and the invisible nature of caloric, Mr. Earle con-
cludes, that the great difficulty of supposing the brain capable of forming any
thing which can pass along the nerves without being seen, and can only be ap-
preciated by observing certain phenomena which indicate its presence, is en-
tirely overcome.
Many physiologists are of opinion that the brain is necessary to secretion,
although the precise mode of its operation has never yet been satisfiictorily ex-
Earle on the Functions of the Nerves* 193
plained. After remarking that there is great reason to believe that the whole
secernent function, comprehending every thing relating to the growth and nu-
triment of the body, and particularly that part of it which constitutes the diges-
tive process, is performed at least as well during sleep, if not better, than when
the body is in motion, and that consequently the action of the brain by which
this function is supported can never be at rest a single moment, Mr. E. remarks,
that he considers this secernent function to be the result of an action of the
whole brain. To this opinion he is led by tv/o reasons: first, because it is proved
by Dr. Philip, that. the action of the heart cannot be affected by a stimulant,
however intense, if it be applied to a small part only, while the motion of this
organ is immediately increased when a stimulant is applied to any part of the
brain, provided the extent of the surface stimulated is considerable; secondly,
because the size of the brain is so small, as compared with that of the body,
that it is scarcely possible to suppose that an action of a part only of this
organ could be equal to the maintenance of all the vital functions. As the
brain is constantly acting, it remains to be inquired in what manner this action
is applied to fulfil its important office. As may be presumed, Mr. E. concludes
that the nerves are evidently the only means by which it can be rendered avail-
able. Before entering fully on this subject, he presents his views respecting
the proper classification of the nerves. After adverting to the classification pro-
posed by Dr. Philip, and remarking that it is rather calculated to perpetuate
errors than to render the study of the functions of the nerves less intricate, he
remarks that the different functions of these, according to what is at present
known of them, should form the basis of their classifications, and that they
should be considered, first, according to the functions which each performs in-
dependently of the others, and secondly, according to their natural arrangement
and the functions which they perform in combination. In accordance with this
plan, he proposes that the term cerebral nerve, instead of being, as hitherto,
applied to every one which passes through an aperture in the skull, should be
restricted to the olfactory, ophthalmic, and auditory nerves, on account of their
being more particularly connected vrih the intellectual functions which are per-
formed by the brain. Owing to these nerves being the most simple in their func-
tions, that of transmitting impressions to the brain, and owing to theirfilaments not
being intermingled with those of any other nerves, he proposes that they should
form the first class. The second class comprehends every nerve by means of
which muscles are subjected to the influence of volition. These are the ante-
rior nerves, and belong to the anterior columns of the spinal marrow. The third
CLASS comprehends every nerve belonging to the posterior columns of the spi-
nal marrow, transmitting impressions from their extremities to the brain. These
nerves have protuberances upon them just before their respective junctions
with the posterior columns of the spinal marrow. Lastly, the fourth class com-
prehends every nerve proceeding from the sympathetic ganglions, and impart-
ing to every tissue, whether of a muscular, (as the heart,) or of a fibrous, (as
the arteries and iris,) texture, a power of motion altogether independent of
any influence that the will can exercise.
"These four classes of nerves are found distributed in four different orders.
The first class, or purely cerebral nerves, are the most simple in their arrange-
ment, because their filaments are never intermingled with those of any other
No. XXVII.—May, 1834. . 17
1:94 Bibliographical Notices.
nerve. These therefore should be considered as forming i\\e first order of dis-
tribntion. The next most simple arrangement is found in those nerves which are
formed by the union of anterior and posterior filaments, or the second and third
classes. These therefore should form the second order. These nerves supply
the bones, muscles, &.c. of the limbs and a great part of the trunk of the body;
and those parts, whose structure is such as to allow of motion, and which
can at any time be called into action by the will."
" The next variation is found in the union of posterior filaments with those
belonging to sympathetic ganglions; or the third and fourth classes. These,
therefore, should form the third order. All parts supplied by these nerves,
whose structure is such as to allow of motion, such as the heart, arteries, intes-
tines, and iris, are observed to be in constant action from birth till death, with-
out becoming exhausted or fatigued, and without requiring rest. The action of
these parts cannot be affected by the will.
" The last variation is found in those nerves which are formed by the union
of anterior, posterior, and sympathetic filaments, or second, third, and fourth
classes. These therefore should form the fottrth order. The muscles supplied
by filaments arranged in this order, are observed to have a power of supporting^,
constant motion without fatigue, but they differ from those supplied by the
third order in being always obedient to the command of the will. The nerves
and function of the diaphragm affords an example of this variety."
The nerves belonging to the first of these orders are single, those belonging to
the second and third are double, and those belonging to the fourth are treble.
While some parts receive anterior, some sympathetic, and others filaments of
both these classes, the posterior filaments are common to all. The reason is
obvious; for whatever difference of motion may be required in different situa-
tions and structures, the maintenance of the healthy state of the various tissues
is necessary to all parts, in order that they may be in a proper condition to act ;
and for this purpose posterior nerves are indispensably required.
Having disposed of this part of his subject, and stated that although the se-
cernent function of the brain is the result of a physical action in it, he will post-
pone the explanation of it as well as of various other phenomena to a future
work which he intends to lay before the public, Mr.Earle, — who seems to have
adopted Reil's opinion, that the nerves of motion spring from the cerebrum^
while the nerves of sensation eventually terminate in the cerebellum, — proceeds
to state the precise manner in which he considers "the influence of the brain,
or more properly the cerebral influence, because it proceeds from the cerebrum,
and not from the cerebellum, is applied by the nerves in order to effect secre-
tion, and to supply the voluntary and involuntary muscles with their power of
contraction."
He remarks, that the action of the anterior nerves is always from the cerebrum
towards their extremities, that of the posterior is exactly the reverse, being,
from their extremities towards the cerebellum ; and that there is no instance in
the whole body of an anterior nerve not being joined to a posterior nerve.
" This arrangement," he continues, " appears to be for the purpose of allowing,
the cerebral influence, which flows along the anterior, to return in a reflux di-
rection along the posterior nerves and posterior columns of the spinal marrow
to the cerebellum ; thus completing a circulation as perfect as that which is
carried on by the arteries and veins, and which I venture to call the cibcc-
LATiox OP THE srERyous SYSTEM." It is to the passage of the cerebral in-
fluence, from the extremity of one nerve to that of another " analogous
Earle on the Functions of the Nerves, 195
to the passing of galvanism from the positive to the negative pole, that I
am inclined to attribute the maintenance of the blood in its fluid state, the
evolution of caloric, the secretion of synovia in the joints and bursae, and, in
fact, the support of the whole secernent function upon which the deposition
of new and the removal of old parts depends. It is further to be observed, that
as this circulation is constantly going on, there is always a certain quantity of
cerebral influence in the anterior nerves, consequently all the muscles to which
these nerves are distributed must always act in obedience to the will, simply
because volition can affect their prime origins which are in the cerebrum."
As may be perceived no provision is made in the above arrangement for the
supply of the viscera. This, according to our author, is effected in the follow-
ing way. Every posterior nerve is provided with a ganglion, (which as they
do not interfere with the transmission of external impressions, evidently per-
form some office which has not hitherto been understood,) in order that part
of the current which is returning in a reflux direction along the posterior
nerves, upon which alone these protuberances are found, may pass at regular
intervals into the sympathetic ganglions. The secernent function of the viscera
must be performed in the same way as in the limbs, and Mr. E. thinks that an
opportunity is offered by the wandering course of the pneumogastric nerves,
for the passage of the same fluid from the extremities of the nerves coming
from sympathetic ganglions, to the extremities of nerves of an opposite charac-
ter, at once providing for the whole secernent function of the viscera. As re-
gards the rest of the returning current, which is over and above what is neces-
sary for the supply of the viscera, it is supposed to pass upwards along the pos-
terior columjis of the spinal marrow into the cerebellum, supplying in its pas-
sage the spinal accessory nerves, so that the muscles to which they are distri-
buted are endowed with the power of maintaining long-continued action with-
out fatigue,
*' Thus the physiology of these nerves, which at first sight appears so diffi-
cult of explanation^ becomes a most convincing proof of the existence of a
CIRCULATION IN THE NERVOUS SYSTEM. Tlic superior ccrvical ganglion of the
sympathetic is supplied from that on the pneumogastric precisely as the tho-
racic, abdominal and pelvic sympathetic ganglions are supplied from the gan-
ghons on the posterior nerves which are in their neighbourhood."
The succeeding chapters of the first section are devoted to the consideration
of the facts upon v/hich the views we have just laid before our readers are
founded. The author first examines the functions of the second order of
nerves, and states his reason more fully than he had done before, for consider-
ing the muscles as dependent upon the nerves for their power of acting; or
what other physiologists have denominated their irritability or excitability. The
objections he presents to the Hallerian doctrine, or rather to Dr. Philip's views,
for it is principally against this experimenter's conclusions that his criticism is
aimed, are rather theoretical and argumentative than the result of counter-expe-
riments ; for throughout the whole of this chapter, he adduces but one single ex-
periment amid a number of arguments tending to show the fallacies of the con-
clusions which Dr. Philip has drawn from his numberless vivisections. Some
of these arguments are highly ingenious and deserve an attentive consideration ;
but we are not disposed to admit, that either they or the experiment he has
detailed are calculated to make us refuse coinciding with those who recognise
196 Bibliographical Notices.
the existence, in muscles, of an inherent power of excitability, independent of
any influence imparted to them by the nerves. But be this as it may, his prin-
cipal reasons for believing' in the necessity of this influence are — that when
animals are deprived of life by lightning* or by any poison which suddenly af-
fects and destroys the nervous system, the muscles cannot be stimulated to con-
tract after death, and that there is no experiment which goes the length of proving,
that muscles when exhausted can recover their power after the division of their
nerves; whereas when the nerves remain entire and uninjured they recover that
power after being- considerably exhausted by frequent contraction.
Mr. Earle next inquires, in a particular manner into the functions of the third
order of nerves — those composed of posterior filaments with branches be-
longing to the sympathetic ganglions, and which supply the heart and vessels
of circulation. He selects a few of the most decisive of the experiments detail-
ed by Dr. Philip, and from which that gentleman had thought himself justified
in concluding that the action of those organs is independent of the brain. His
object in selecting those experiments is to show the difference of effect pro-
duced, by destroying suddenly, or slowly, or by wholly removing the brain and
spinal marrow, both in warm and cold-blooded animals; and that all involuntary
motion is injured in proportion to the degree of injury committed upon the ner-
vous system — a circumstance from which he concludes, that no further evidence
is wanting to prove that involuntary, as well as voluntary motion, is entirely de-
pendent on an influence derived from the brain, and that the nerves themselves
have undoubtedly an action to a certain extent independent of the brain and
spinal marrow, precisely as the minute vessels of circulation have an action to
a somewhat similar extent independent of the heart. These opinions are,
he thinks, strongly corroborated by the observations of Flourens and Marshall
Hall, who have taken notice of the gradual cessation of the circulation v^^hich
follows the careful removal of the brain, commencing in the most minute extre-
mities of the blood-vessels, where provided the brain be the original source
whence the nerves derive their influence or power, it is in the failure of the
action of these minute vessels, on account of their being most distant from the
brain, that we should naturally expect the effect of its removal would be first
perceptible.
••In thus ascending from effects to causes, it is found, that the brain is the
source whence the influence of the nerves is derived, and that these again have
the power of distributing it for a short time after the removal of the brain so
long as any influence remains in them, precisely as they did before the connexion
was interrupted; but it must not be forgotten, that the moment at which the
brain is either removed or destroyed, is exactly the time at which the failure
of all motion commences. These facts and observations lead to the inference,
that the same relation subsists between the brain and nerves, as between the
heart and arteries; the brain being the source whence the nerves derive their
influence, the heart the source whence the arteries derive their supply of
blood."
Mr. Earle is of opinion, that the experiments which Dr. Philip instituted to
show, that the action of the heart and vessels of circulation may be influenced
by stimulants and sedatives applied to the brain and spinal marrow, prove the
fact sufficiently well. On this subject he makes the foliowing remarks.
" The terms stimulant and sedative are used to express nothing more than
Earle on the Functions of the Nerves. 197
increase and diminution. At the time of the commencement of these experi-
ments the heart was beating, and the apphcation of either the one or the other
to the brain or spinal marrow excited no new action either in the brain or in
the heart, but simply caused an increase or diminution, or in other words, a
variation of what already existed. As the increased or diminished action of the
heart was the result of a corresponding action of the brain caused by the appli-
cation of either agent, so the ordinary action of the heart is necessarily caused
by the ordinary action of the brain, and as the former invariably ceases to beat
soon after the removal of the latter, it must be concluded, that so long as the
heart is acting in the perfect animal, the brain is acting also."
Mr. Earle next inquires into the dependence of the secernent function on
the nervous system. This function, he remarks, comprehends, besides the forma-
tion of particular secretions and excretions, the growth and nutrition, the depo-
sition of new and the removal of old parts throughout the whole body. As the
blood is evidently the fluid from which all functions are formed, the first step
in this inquiry is, he thinks, to ascertain the cause of its fluidity. On this sub-
ject, to which he appropriates a separate section of his work, he adopts the
conclusions of Dr. Wedemeyer, who regards the cause of this fluidity to be de-
pendent upon an influence of the nerves upon the blood. He enters into along
discussion to prove that nervous influence and galvanism are not identical. He
adopts the views of Wedemeyer and other anatomists who maintain that the
blood in the finer capillaries no longer flows within actual vessels, whose pa-
rietes are formed by a membranous substance distinguished from the adjoining
cuUular tissue by its texture and compactness; but in simple furrows or canals,
whose walls are formed by the surrounding cellular tissue ; and remarks, that
while these observations appear decisive as to the place in which secretions are
formed, the fact, that small arteries receive an increased supply of nerves in
proportion as their size diminishes, seems to point out, in a manner scarcely to
be misunderstood, the power by which secretions are formed. He inquires
whether this function is performed exclusively by the third order of nerves, or
■ by the sympathetic system ; and comes to the conclusion, from the results of the
experiments of Magendie on the fifth pair, and of others on the pneumogastric —
" Not only that every posterior nerve is concerned in performing secretion,
but also, that the economy of the sympathetic ganglions has more relation to
the means whereby the motions of the parts supplied by them maybe constant
and independent of the will, than to any difference of secernent function."
On the subject of the cause of animal heat he adopts the opinions of those
who attribute this, phenomenon to the influence of the nervous system, and
quotes from Mr. Adelon's elaborate work on physiology, a detail of the experi-
ments of Mr. Chossat, of Geneva.
That part of his work on which Mr. Earle seems to attach most importance,
is that in which he inquires into the " mode in xohich by means of the nerves the
CEREBRAL INFLUENCE is Tendered available in maintaining the motor an J se-
cernent functions of the animal economy ." In this section and in the succeeding
he endeavours to sustain the theory laid down in his first chapters respecting
the circulation of the nervous system, and the manner in which the sympathetic
nerves receive their portion of nervous influence — a theory of which we have
already off'ered a sketch. Without entering here into any details upon this
.subject, or examining the grounds upon which he endeavours to establish his
...17*
198 Bibliographical Notices.
views, we may remark that the whole theory appears to us to be more fanciful
than plausible, and to rest more on speculation than on the result of close ob-
servation and well-devised experiments.
There is no doubt, and it did not require the work under review us to apprize
of the fact, that there exist nerves whose office is to convey the influence of the
will from the brain to the muscles — and others destined to carry to the brain
a knowledge of impressions made on surfaces of relation, or in the substance of
the tissues ; but we may reasonably doubt that things take place exactly as Mr.
E. describes them.
Mr. E, starts from the fact, that the anterior branches of the spinal marrow
are nerves of motion, and the posterior nerves of sensation, and that the same
facts are also proved by experiments upon the anterior or posterior columns of
the spinal marrow. It is thus plainly demonstrated, he remarks —
" That the influence of the will or of the brain cannot be transmitted to the
voluntary muscles through the posterior columns or the filaments belonging to
them ; and that external impressions cannot reach the brain through the an-
terior columns or the filaments arising from them ; any influence or impression
so conveyed by either set of nerves would be retrograde, and contrary to their
usual fixed mode of action, from which they cannot deviate. There is no action,
therefore, in an anterior filament, except /rom the brain to its extremity,- neither
is there any action in a posterior filament, except //-ow its extremity to the brain.^*
Our readers will immediately perceive that this is taking for granted, as a
fact proved beyond the possibility of doubt, a circumstance on which the ablest
physiologists and experimenters are yet undecided, and which even if true would
not prove the correctness of Mr. E.'s theory, but only aflTord us clearer views
than we possessed respecting the precise origin and termination of the nerves
of motion and sensation. The question is whether there is a constant passage of a
fluid from the nerves of motion to the nerves of sensation — whether that fluid is
the same in both orders of nerves. Now it may be objected to Mr. E.'s theory that
if it is the same fluid which goes down one nerve and up another, we should be
at a loss to explain how these two nerves can be enabled to perform func-
tions of a very different nature, and that if we admit that the same fluid which
going up towards the brain along a nerve of sensation, imparts motific power
to another set of nerves which it encounters in its way upwards— the sympathetic
and the accessory nerves, the difficulty would be rendered still greater. All
this certainly is not very clear. In his opinion the precise mode in which the
cerebral influence is rendered available for the accomplishment of the whole of
that part of the secernent function upon which the growth and nutrition of the
body depends, is easily understood; and is well illustrated by the well-known
fact, that galvanism exerts its influence upon chemical substances in passing
from the positive to the negative pole: but this is merely a supposition, and
leads to no conclusion. In adducing arguments in proof of the existence of the
circulation of the nervous system, such as he understands it, he makes the fol-
lowing remarks, which may not, perhaps, appear as satisfactory and conclusive
to all our readers, as they do to himself
« As I know of no reason which should induce me to suppose that this circu-
lation does not exist, nor of any physiological fact or experiment which proves,
that it is incompatible with the more obvious functions of the nerves relating
to volition and sensation, and therefore cannot take place, I think that I am
Earle on the Functions of the Nerves. 199
justified in believing that there is a circulation in the nerves of a subtile fluid
somewhat similar to electricity, passing as regularly and uninterruptedly along
them from and to the brain, as there is of blood in its vessels from and to the
heart."
In a chapter on the functions of the fourth order of nerves, or that formed by
a union of anterior, posterior, and sympathetic filaments, Mr. Earle contends
for the existence of a distinct class of muscles, differing from the voluntary and
involuntary in the circumstance, that, though like the former, they are entirely
subject to the regulation of volition, their action is continual, and they never
require rest.
"The power of the will," he says, " over these muscles is only exerted oc-
casionally as convenience or necessity may require, and is employed solely in
increasing their action; but volition has no more power of stopping or prevent-
ing their action, than it has of interfering with that of the heart."
The muscles of the face, the intercostals, and the rest of the respiratory
muscles, belong to this class. Mr. E. remarks, that the cause of this pecu-
liarity in the action of these muscles is not to be either found or sought for in
any difference in their structure, any more than in that of the purely voluntary
or the purely involuntary muscles, but in the nerves by which they are sup-
plied. He calls attention to the fact, that this class of muscles is supplied by the
fourth order of nerves — that their involuntary action is provided for by means
of branches from sympathetic ganglia — that they are subject to the will through
the anterior nerves ; and that they have posterior filaments, in order that the
healthy condition of their structure, upon which their fitness to act dependsj
may be constantly maintained. This order of nerves is very numerous, and ex-
tensively distributed. It comprehends the third, fourth, fifth, sixth, portio dura
of the seventh, glosso-pharyngeal, the primary branches of the pneumogas-
tric, the ninth, and the anterior branches of all the spinal nerves, with the ex-
ception of the fifth, sixth, and seventh cervical.
"Considerable attention has been paid to some of the nerves of this order in
consequence of the pubhcation of Sir C. Bell's opinion respecting those which
he has termed ' respiratory.' The basis upon which these peculiar opinions restj
appears to be the idea of there being a certain part of the superior portion of
the spinal marrow expressly devoted to the regulations of the motions of respi-
ration, * a tractus respiratorius,' and that every nerve belonging to this tractus is
especially destined to combine and assist in the performance of respiration, as a
necessary consequence of its connexion with that particular part. I have found
it impossible to adopt these views, for the following reasons ; First, it is by no
means clear that the tractus respiratorius has any existence : Secondly, some of
the nerves termed respiratory arise from the anterior, others belong to the pos-
terior, while the phrenic belong equally to both columns of the spinal marrow.
These facts are altogether subversive of their arising from any one particular
part; lastly, in classing the pneumogastric as a nerve of motion. Sir Charles is
at variance with the results of his own experiments, which show that no poste=
rior ganglionic nerve has any thing to do with motion."
The last nerves which Mr, E. notices, are the spinal accessory nerveso
Though last, he says, they are the most important as regards the proof they af-
ford of the existence of the circulation of the nervous system. He relates an
experiment of Sir Charles Bell, who states, that if we expose this nerve, and
200 Bibliographical Notices,
then induce excited respiration, so as to bring- the mastoid muscles into power-
ful action in combination with the other muscles of respiration, and if, while
this action is performed, we divide the nerve, the motion ceases, and the mus-
cles remain relaxed until the animal brings them into action as voluntary
muscles.
From this he concludes, that, without enteringinto any speculation on the re-
spiratory functions of these nerves, it is evident that they bestow a power of
involuntary motion upon the mastoid and trapezius muscles. There is a great
necessity for this muscle having a power of involuntary motion to enable them
to act constantly v^ithout becoming fatigued in moving and supporting the
head, a function which muscleSj supplied only by anterior and posterior nerves,
would be by no means equal to.
"It is to be observed that the spinal accessory differs from all the rest of the
nerves which belong to the posterior columns of the spinal marrow in several
points. First, the most obvious difference is in the direction of the course of their
filaments, which is fram below upwards. The second is in their having no protu-
berance or ganglion upon them, either before, or at their emergence from their
bony canals. The third in being motor nerves. They further differ from the rest
of the posterior nerves in that, as the motor power which they bestow upon their
muscles must be derived from the spinal marrow, they arise from, while the lat-
ter terminate in, the posterior columns." " The only point which now remains to
be explained, is how they receive the influence which they bestow upon tl>e
muscles. The direction of the course of their filaments precludes all idea of
their influence being directly derived from the brain, even if the fact of their
being involuntary did not discountenance such an opinion. It must therefore
come from the posterior columns of the spinal marrow, and unless there is an
upward returning current along these columns towards the cerebellum, the
physiology of these nerves is absolutely inexplicable; but if there is such a cur-
rent as that which I have endeavoured to show the nervous system is well
adapted to carry on, it is precisely that which is most admirably calculated to
provide a supply of nervous influence; constantly, because the action of the
brain is constant; and involuntarily, because the will can have no power over
the nerves along which it flows. According to this explanation, all the difficul-
ties which have hitherto appeared to present insuperable obstacles, and to baf-
fle every attempt to elucidate the physiology of the spinal accessory nerves,
actually combine to afford the most beautiful confirmation of the existence of
the circulation of the nervous system, which could possibly have been imagined.'*
We have thus endeavoured to present in as concise a manner as possible
some of the facts and inferences which have induced Mr. Earle to believe that
there is a circulation in the nerves, and that instead of there being several sepa-
rate and independent vital powers, there is but 0]?fE, upon which every func-
tion necessary to the continuance of life depends ; so that all the various phe-
nomena result not from the exercise of different powers, but from a difference
in the mode of the application of one and the same power. From what we have
already stated in the course of this article, it may be seen, that we are not pre-
pared to acquiesce in all the views of our author. We might, had we time and
space sufficient at our disposal, show that on several other points besides those
adverted to, the positions he assumes are very far from conclusive, and that he
has particularly erred in respect to the functions ascribed to the pneumogastric
nerve ; but as the consideration of these subjects would lead us further than we
<;an conveniently gCs we mustabstain from it. We close our analysis with the
Voisin on Digestion. 201
remark, that the work before us affords evidence of considerable talent in the
author, and induces us to hope that Mr. Earle will soon favour the medical pro-
fession with his promised volume on the function of the brain, but that we have
been at a loss to discover in it those great discoveries — those very new views
concerning the functions of the nervous system which were so pompously pro-
claimed in the commencement and in other parts of the work. The only novelty,
perhaps, is the supposed existence of the nervous circulation, and the mode in
"which the sympathetic and accessory nerves are furnished with their portion of
power. These views, however, as has been seen, are far from being very satis-
factory. As regards the continuance of the influence of the brain on the heart
and viscera even in the ordinary state of existence, and the property of the
sympathetic, to remove, under particular circumstances, the organs from under
the controul of the will, which at ordinary periods are subject to its influence,
and to enable them to continue their action without repose, Mr. E. has been an-
ticipated by many physiologists, and among them by M. Broussais, whose writ-
ings should be in the hands of every physician, and cannot, we may presume,
be unknown to Mr. Earle. L.
XVI. Nouvel Apergu sur la Pkysiologie du Foie et les Usages de la Bile. Be la
Bigesiion ConsiderSe en General. Par Benjamij^t Voisin, D, M. P. Paris,
1833. pp. 146.
New Observations upon the Physiology of the Liver and the Uses of the Bile, and
upon the General Subject of Bigesiion. By Benjamin Voisin, M. D.
Although we cannot accord the appellation novel to all the observations of M.
Voisin, in relation to the physiology of the liver and of the digestive organs
generally, they are nevertheless in the highest degree interesting. He has,
it is true, advanced a few opinions in the course of his essay, the correctness of
which will admit of very considerable doubt, but generally speaking his con-
clusions are based upon numerous facts and experiments, from which they ap-
pear to be legitimately deduced, while they certainly afford a much more satis-
factory explanation of the several disputed points to which they refer, than
those adopted by the majority of physiological writers.
As we have just hinted, many of the observations of M. Voisin are rather
old opinions revived than original suggestions of his own. The credit is due
to him, however, of placing them in a somewhat novel point of view, and of
illustrating them by a variety of interesting and appropriate facts and experi-
ments, in the collection and performance of which he has exhibited no little
industry and skill.
The primary subject to which the observations of the author refer is the
physiology of the liver. To this the first five chapters of the essay are devoted,
and it is again repeatedly referred to in the subsequent part of the work.
The liver M. Voisin considers to be a secretory organ, the office of which is
the depuration, not only of the venous blood, but also of the chyle, previously
to the entrance of the latter into the thoracic duct. The bile, he maintains, is
purely excrementitious and composed of the effete particles of the organs car-
ried into the circulation by the absorbents, and of certain substances taken up
by the lacteals with the chyle, and which are not adapted to nutrition. He ad-
2Q2 Bibliographical Notices.
mits, however, that the bile may act as the natural and necessary stimulus by
which the peristaltic motion of the intestinal canal is excited and kept up.
In reviving- thus the ancient, but by no means exploded, opinion that the liver
is in fact the primary organ of hsematosis— in other words, that by its action a
species of purification is produced in the chyle, by which the latter is rendered
more fit to mingle v/ith and form a part of the blood — M. Voisin has attempt-
ed to estabhsh its correctness by showing- that all, or at least the major part, of
the lacteals, before they empty their contents into the thoracic duct, pass
through the substance of the liver.
The lacteal absorbents, he remarks, after passing- a certain distance, anasto-
mose with each other, enlarge in size, and are collected together so as to form
a kind of plexus below the lobe of Spigelius, towards which they converge.
From this point they penetrate into the substance of the liver, through which
they ramify with great minuteness, and finally empty themselves into the reser-
voir of Pecquet.
"To prove that the chyliferous vessels do pass through the liver, in their
course to the thoracic duct, it is only necessary to put a ligature around the
latter below the diaphragm, in a dog, after he has partaken of a large quantity
of food, and when digestion is presumed to be in full activity. The lacteals
will then sv/ell and become very apparent, their whitish colour being- distinctly
perceived. In consequence they may, without much difficulty, be traced from
the interior of the intestinal canal, through the mesenteric glands, until their
entrance into the liver."
The foregoing- opinion in relation to the course of the lacteals through the
substance of the liver, is one which appears to have been entertained as early
as the period when those vessels were first discovered. Asselli, who in 1622
detected the chyliferous vessels in quadrupeds, denominated them chylous
veins, and describes them as terminating, like the other veins of the intestines,
in the liver. Subsequently, Weslingius, who discovered the same vessels in
the human subject, and traced them in their course towards the thoracic duct,
states that a large number of them penetrate the liver.
The ancients, who believed that the chyle underwent in the latter organ cer-
tain chang-es, referred its conveyance thence not to th« lacteals, but to the me-
saraic veins. This opinion has been revived and advocated by several distin-
guished physiologists of the present day, among whom we may name Magen-
die, Gmelin, Tiedemann, and Kibes.
The spleen is considered by M. Voisin as an appendage to the liver. Its
principal use being to receive and to furnish to the latter blood containing those
materials which enter into the composition of the bile.
The heart, by means of its columnae corne3e, causes, according to our author,
a separation of the arterial blood into two distinct portions, which, however, cir-
culate in the same vessels, side by side, but without mixing with each other.
The one portion, the most pure, the most aerated, and the lightest, passes into
the aorta to the left, and when it arrives at the arch of that vessel is thrown
into the three principal branches that are distributed to the superior parts of
the body. The other portion, less pure and heavier, is conveyed to the abdo-
minal organs and inferior extremities.
This latter portion of the blood, in its passage through the several secretoiy
organs placed along its route, is deprived of certain of its ingredients, and in
Voism on Digestion. 203
consequence of this successive purification, when it arrives at the lower parts
of the body, will be found to differ but little from that which is distributed
to the superior organs.
The more impure of the two portions into which the arterial blood is sup-
posed to be divided by the heart, is composed, according to M. Voisin, princi-
pally of the chyle newly transformed into blood, and which has undergone but
once the process of hsematosis. It is not adapted, therefore, for the support and
vivification of the more important organs, and especially of the brain, until it
has been more fully assimilated in its nature to arterial blood. This second
process of hzematosis it is the office of the liver to effect.
This fanciful notion of the division of the arterial blood, by the heart, into
two distinct portions, our author attempts to prove by direct experiment. Into
the left cavities of the heart of a dog, immediately after the animal had perish-
ed from haemorrhage, he forcibly injected at one and the same time, two fluids^
differing in colour and consistency; the most fluid being blue, and the otker
red. On opening the heart and aorta, it was found that the two fluids remained
side by side unmixed; the blue occupying the left portion of these organs and
filling principally the arteries distributed to the head and superior parts of the
body, while the red occupied the right portion of the cavities of the heart and
aorta, and was found to fill the abdominal aorta and its branches.
If this division of the arterial blood into two distinct portions be admitted,
remarks M. Voisin, it will be seen that the liver, the spleen, the intestines, and
nearly all the abdominal viscera, receive a blood, not less nutritive perhaps, but
less pure, less homogeneous, than the other parts of the body, but at the same
time of a quality which is precisely that adopted for the formation of their va-
rious excretions.
The blood which is returned from those organs which separate from it excre-
mentitious fluids is, in consequence of the elemination of the latter, in a state
fit for mixing immediately with the common mass of the venous blood. That
which is transmitted to the inferior cava by the hepatic and renal veins is of this
kind; but that returned from the spleen, having undergone no depuration, can-
not return directly to the heart, it must previously pass into the liver and be
there deprived of those elements which serve for the formation of bile.
The spleen, then, is an organ for the circulation of the blood the least hsema-
tosed, upon which it has scarcely any other effect than to change it from arte-
rial into venous.
The large size of the splenic artery, its origin from the ccelic trunk, fopisto
gastrique,J immediately after the entrance of the aorta into the abdomen, and
its distribution through a spongy tissue, cause the spleen to be one of the first
and principal centres of fluxion for the blood upon its passage from the heart.
The blood of the splenic vein is, according to our author, of a peculiar cha-
racter. It has already the oily nature of bile, and appears to be composed of
the debris of the organs.
To prove that the bile is not necessary for the separation of the chylous from
the excrementitial portion of the chyme in the duodenum, M. Voisin adduces,
Istly. The fact that there are animals which are destitute of any organ analo-
gous to the liver, and yet digestion and assimilation are performed in them as
perfectly as in such as possess that organ.
204 Bibliographical Notices,
Lieutaud, in his Medical Anatomy, fLih. I. 190, J reports an observation of
Gaspard Bauhin, under the title * Hepar dejidens* It refers to an individual in
the body of whom, after death, no trace could be found of either liver or spleen.
The parietes of the intestines were very thick and fleshy, and upon them ter-
minated the branches of the vena portse. 2dly. That the opening- of the ductus
choledocus into the duodenum, by which some consider the importance of the
bile in chylification to be established, is not invariable in all animals; in some
of the inferior classes the excretory duct of the bihary apparatus opens near
the anus, which proves that in such animals at least the bile is a mere excre-
ment. 3dly. That the functions of the liver are active in the foetus before the
digestion of food can take place.
" The blood brought from the placenta by the umbilical vein, although arte-
rial, is not, however, sufficiently pure to be distributed immediately to the de-
licate organs of the fcEtus. In passing through the uterine vessels and the pla-
centa it loses in some degree its vivifying properties, and acquires, in part,
the properties of venous blood, becoming more gross and oily, and charged
with hydrogen and carbon. Of these it is necessary that it should be de-
prived in the vessels of the liver, which latter acts, in regard to the foetal blood,
the same office nearly as the lungs do in the adult."
The secretion furnished by the liver in the foetus is the meconium. In exa-
mining the composition of the dark-coloured, viscid paste found in the bowels
of new-born infants, we find it to be composed of the same elements as the bile.
Portal states positively that the meconium is nothing else than bile, and accord-
ing to the analysis of Vauquelin it is bile mixed with mucus. Thus we find
that before as well as subsequent to birth the bile is purely excrementitial. That
in the foetus it is not concerned in chylification is proved by the fact that no
chyle is then formed. We can readily conceive that after birth, when the di-
gestive function is fully established, there must necessarily be a considerable
difference in the quantity as well as in the quality of the materials separated
from the blood by the liver, and consequently in the amount and composition of
the bile secreted.
4thly. M. Voisin has attempted to show that the bile is not concerned in the
formation of the chyle, by numerous pathological observations, in which, from
disease of the liver, the secretion of bile was greatly diminished or entirely
suspended, or in which its entrance into the intestines was prevented com-
pletely, and yet digestion and assimilation experienced little or no interruption.
5thly. By direct experiment he has shown, that the occlusion of the com-
mon duct of the biliary apparatus does not prevent the formationof chyle? pro-
vided the passage of the pancreatic fluid into the intestine is not at the same
time prevented. In a number of dogs a ligature was apphed around the ductus
choledocus, so as completely to prevent the entrance of the bile into the intes-
tines. Two of the animals lived three months after the experiment, three sur-
vived six weeks, and five died shortly after the ligature was applied; in no in-
stance was death produced by the suspension of digestion or assimilation. Al-
most all the dogs had commenced to eat, and in the majority there was found
in the duodenum food perfectly chymified, and well-elaborated chyle in the
lacteals. In one instance, the liepatic and cystic ducts and gall-bladder became
enormously distended with bile, and death was occasioned by the rupture of
Voisin on Digestion. 205
the coats of the gall-bladder and the escape of the bile into the peritoneal ca-
vity. With the exception of extensive inflammation of the latter, no disease of
the abdominal viscera was detected. The stomach and intestines were filled
with aUment almost entirely digested, and the lacteals were distended with
chyle. Of the latter nearly half an ounce was procured.
Having disposed of the physiology of the liver, and the inquiry into the uses
of the bile, M. Voisin considers next the subject of digestion in general. His
remarks and experiments in relation to this important process of the animal
economy are deserving of very considerable attention. It is not our intention,
however, to give, on the present occasion, any thing more than a very brief
sketch of our author's views in relation to the various points connected with it;
merely noticing, as we pass along, the nature of his experiments and their
results.
M. Voisin denies that the process of digestion, properly speaking, is confined
solely to any one portion of the alimentary canal. From its entrance into the
mouth, until the last portions of nutritive matter are completely separated from
those which are excrementitial, in the lower part of the intestinal tube, he in-
sists that the aliment is continually acted upon, and undergoes a succession of
changes, the sum of which constitutes the process of digestion. The action
of the stomach and its juices, is, he admits, of the very first importance, but
by no means, as he has attempted to prove, essential to chylification. Diges-
tion, under ordinary circumstances, during a healthy condition of the body,
commences in the mouth, and terminates only when the contents of the intes-
tines have arrived in the rectum.
The identity of organization of the different portions of which the digestive
tube is composed, proves, he remarks, that they all assist in producing in the
food those changes which are necessary for the separation from it of its nutritive
principles, while it enables, also, one portion of the apparatus to supply to a
certain extent the defective action of another.
During the short time the aliment remains in the mouth, it undergoes, accord-
ing to our author, a very important modification. Its texture is broken down
by the teeth, and, at the same time, it is intimately mixed with the salivary
fluids. In consequence of these acts, its appearance and composition are in a
great measure changed. Although the different particles of which the food was
composed are still recognisable, yet, after the latter has undergone this, as our
author terms it, "first digestive elaboration," they have become much more
homogeneous.
The change produced in alimentary substances by commixture with the sa-
liva, M. Voisin maintains, do not, as some suppose, consist in a simple me-
chanical division and their conversion into a soft paste, by which their degluti-
tion is facilitated; it is something more. By mastication and the action of the
saliva, a commencing decomposition is produced in the food. It is well known,
that the articles of food which have been the most completely masticated and
combined with the saliva become most promptly chymified in the stomach; and
when, in place of being swallowed, they are rejected from the mouth, they be-
come sour and putrify in a very short time; which facts M. Voisin adduces as
proofs of an actual and very important change having been effected in their
composition.
No. XXVII.— May, 1834. 18
206 Bibliographical Notices*
The author submitted food to the action of the saliva at a temperature similar
to that of the human body, and found that when the latter was slightly acidified
the same changes occurred as are produced by the action of the gastric fluid
under similar circumstances.
The food having arrived in the stomach, it is subjected there to the action of
that organ and its juices, by which, in a shorter or longer time, according to
its nature and other circumstances, it is converted into chyme.
M. Voisin admits the existence of a gastric solvent. Nothing, he observes,
disproves the possibility of the secretion of a solvent fluid from the coats of the
stomach taking place, at the moment the aliment enters that viscus, in conse-
quence of the peculiar excitation which the latter receives from the presence
of the food.
Artificial digestion, as it is termed, although very far from representing
exactly that which takes place in the stomach, nevertheless proves very fully,
he conceives, the solvent action of the gastric juice.
" Like all the other products of exhalation, the action of the gastric solvent
cannot be separated from that of the organ by which it is furnished. Its in-
fluence, as we may well suppose, is subordinate to the vital action of the sto-
mach. It is in consequence of its particular state of sensibility and vitality
during the period of digestion, that the latter is enabled to furnish a fluid
adapted to the solution of the food which it contains, and consequently there-
fore to its conversion into chyme."
Hence, according to M. Voisin, the process of chymification is a complicated
one, in the performance of which, he insists, we cannot separate the action of
the stomach upon the food from that of the gastric juice, and vice versa. The
stomach is the organ to which the important act of chymification is confided,
and the gastric juice a mean placed at the disposal of that organ to enable it to
perform its functions.
The gastric juice penetrates, liquefies, and combines with the different arti-
cles of food, altering completely their character, and changing their intimate
composition, so that they are no longer recognisable. In effecting this change,
the gastric fluid is aided by the stomach, which is by no means an inert re-
ceptacle, but, on the contrary, takes a very active part in the act of chymifi-
cation.
According to the observations of M. Voisin, the gastric juice is not supplied
merely to an extent sufficient for the solution of the food taken into the stomach,
but is always in excess. "It is far," he also remarks, "from being identical in its
properties in all species of animals; it is not so even in the same animal at all
times, as Chaussier has very clearly shown. It differs considerably according
to the nature of the food which is eaten." It is sometimes eminently acid; in
other cases it is more or less alkaline, changing to green the syrup of violets
and other vegetable blues. These facts, M. Voisin states, he has verified by
numerous experiments.
*' The possibility of my being able to establish in a manner so positive, the
character of the gastric juice, under the different circumstances referred to,
will, he remarks, no doubt be contested; and this in consequence of the diffi-
culty of obtaining the fluid during the period of digestion, and of separating it
perfectly from the food, which might possibly communicate to it an alkaline
property, and hence impair the correctness of the experiments. I will merely
Voisin on Digestion. 207
state in reply, that when I have desired to test the properties of the gastric
juice, I have always experimented with that fluid, when I was certain that it
was pure and without foreig-n. admixtures, such as was furnished by an animal to
which, after fasting-, food was presented, and by that means the exhalation of
the gastric juice produced."
The observations of M. Voisin confirm those of Chaussier, Wilson Philip, and
numerous others, in proving that chymification always takes place from the
circumference of the aliment contained in the stomach by successive layers.
During digestion, remarks our author, the stomach does not remain quies-
cent; it contracts in a manner continuously, pressing in every direction the food,
and after a movement of peristole, which pushes the contents of the organ from
its splenic to its hepatic extremity, and from the latter back again, it causes it
finally to pass to the pyloris, the resistance of which is overcome, and the chy-
mified portion of the food passes into the duodenum.
The changes which the chyme undergoes in the upper portion of the small
intestines are difficult to detect. Every thing induces the belief, according to
our author, that they are very analogous to those which take place in the sto-
mach; but what agents, what fluids produce those changes in the duodenum,
we are as yet entirely ignorant. Most physiologists are of opinion, that they
are eff'ected by the action of the pancreatic juice and the bile, with which the
chyme is there combined. That bile, at least, is not essential to chylification,
M. Voisin, as we have seen, has attempted to prove, and as we conceive, he
has established the fact in the most conclusive manner. In addition to the ar-
guments on this subject already referred to in his chapter on digestion; in the
duodenum, he remarks, if the bile be really concerned in chylification, and
is the agent by which the chyle is separated from the chyme, the results ob-
tained by testing its action upon the latter out of the body ouglit to be even more
striking than those from the action of the gastric fluid upon food. He however
undertook a number of experiments to ascertain the effects produced by the
bile upon the chyme, but no chyle could in this manner be produced, nor in
fact any change which was not referrible to the sensible properties of the bile.
According to Haller, the changes in the chyme necessary to the separation
from it of the elements of the chyle, are produced by the action of the fluids
secreted by the intestines in the same manner as the changes which the food
undergoes in the stomach are effected by the fluids of that organ. This opinion,
founded upon the resemblance, or rather perfect identity of the gastric and in-
testinal fluids, and the little difference in the appearance of the chyme during
its continuance in the duodenum, has, according to our author, very strong
presumption in its favour. By conceding its truth, we admit the vital action of
the intestines, while by the received opinions, this is entirely lost sight of. M.
Voisin conceives that the pancreatic juice has likewise a very important agency
in effecting the separation of the chylous from the excrementitious portions of
the chyme.
To prove that the solvent properties of the intestinal fluids are similar to
those of the gastric juice, the author, from the intestines of animals kept some
time from food, procured a quantity of mucus, in which, slightly acidified, he
immersed portions of flesh, and kept the mixture at a temperature equal to that
of the living body.
208 Bibliographical Notices.
"At the end of from twenty-four to thirty-six hours, the flesh was in general
converted into a grayish somewhat homogeneous paste. Vegetable substances
however, particularly the herbaceous, experienced no change. To effect com-
pletely the change of the aliment into a chymous pulp, about six hours were
required."
In another series of experiments he introduced into the small intestines of
animals a portion of aliment, in the one case masticated and mixed with saliva,
and in the other without any preparation, and found that in a few hours in the
first instance, and after a longer period in the second, it was as completely chy-
mified as if the process had taken place in the stomach. The same experiments
were repeated upon animals in which the pylorus was secured by a ligature,
with similar results. One of the animals lived for a month after the pylorus was
tied, being nourished during that time by the food introduced into the duode-
num.
•'As we approach the inferior portion of the ileum, the digestive powers of
the intestinal tube will be found gradually to diminish; chymification and espe-
cially the absorption ef chyle, requiring a longer time for their accomplishment
than in the superior portion of the digestive canal, either from the intestinal
fluids being furnished with less abundance, or rather because the absorbent
surface is here less extensive, and supplied with fewer chyliferous vessels.
However we have no reason to doubt that chymification, though less prompt, is
nevertheless completely effected, for its most immediate effect, the formation
of chyle, is still evidenced. We have recognised the latter fluid in the lacteal
vessels and thoracic duct, when it could not have been derived from any other
source than the absorbents of this part of the intestinal canal, a ligature having
been applied so as to cut off all communication with the upper portion of the
small intestines."
In the coecum, ascending colon, and a part of the transverse arch of the latter,
chymification is still performed, though less perfectly, and the few chyliferous
absorbents which exist in this part of the canal, separate from the aliments its
nutritive principles. The fact of the formation of chyme in the coecum and
colon is proved by experiments performed by introducing food into these intes-
tines after the ileo-coecal valve had been closed by ligature.
Thus we perceive that in the different portions of the alimentary canal the
food is subjected to numerous successive transformations. That by the action
upon it of the saliva, of the mucous and follicular exhalations, the gastric juice,
the pancreatic liquor, the intestinal fluids, it is softened, chymified and changed
in such a manner as to adapt it for the formation of chyle, while the remaining
unnutritlous portion becomes by degrees converted into excrement. In fact,
remarks our author, this last process of digestion does not occur excepting in
aliment that has undergone chymification. Those parts of the food which re-
main unacted upon by the digestive organs, and of their fluids, are rejected in
precisely the same state in which they were taken into the stomach, and do not
properly constitute the feces, but are mixed with them.
Although digestion properly speaking is a complicated process, which may
be divided into successive periods, it nevertheless presents throughout a per-
fect unity of action to which concur one and the same class of agents. The
same mucous membrane, similar in its texture, sensibility and mode of vitality,
extends from the mouth to the anus, and which we have every reason to believe
possesses a perfect similarity of function throughout its whole extent.
Copland's Dictionary of Practical Medicine, Sec. 209
Dig-estion consists, therefore, according to our author, in the breaking up of
the texture, the solution and preparation of the aliment by mastication, and the
different fluids furnished by the mouth, stomach, pancreas and intestines, so as
to enable the chyliferous absorbents to separate and remove from it those ele-
ments which enter into the composition of chyle. That this separation and re-
moval of nutritive particles from the dissolved and decomposed food commences
in the stomach, is peculiarly active in the upper portion of the small intestines,
and though still effected, becomes less and less as the chyme passes along the
Intestinal tube, until it is finally reduced to pure excrement in the rectum.
That chyle is formed by the vessels of the stomach, is proved by the experi-
ments of M. Voisin. If we open the stomach of an animal two hours after it
has eaten, he remarks, when we suppose that digestion is in full activity, we
observe upon the surface of the chyme a fluid of a grayish-white, the same as
in the duodenum; if by a ligature we arrest the course of the fluids through the
gastric absorbents, these will become swollen and enlarged, and by dividing
them we procure a white liquid, which is precisely similar, excepting that it is
rather more serous, to that obtained from the same order of vessels which have
their origin in the duodenum.
"I have nourished during fifteen days a dog, around the duodenum of which
I had passed a ligature immediately below the pylorus. Its appetite for food
was excellent, the animal eating frequently, but little at a time. As soon as
the stomach had separated the nutritive principles of the food, the remainder
was rejected by vomiting, or rather by a kind of regurgitation. It is proper to
remark that the rejected portion was less altered, less excrementitial than if
it had been discharged after passing through the whole length of the intes-
tines."
" The existence of chyliferous vessels in the stomach being well established,
the formation of chyle in that organ cannot be questioned. It hence follows
that the presence of bile is not indispensable to the accomplishment of chyli-
fication."
The remaining chapters of M. Voisin's essay are devoted to an examination
of the morbid affections of the liver, with a view of deriving from them evi-
dence of the nature and uses of the bile. The author presents some very in-
teresting views of the pathology of the liver, and particularly of the causes of
jaundice. Of these, however, we cannot on the present occasion present any
thing like a satisfactory sketch, and shall therefore be obliged to close here our
notice of the very interesting and in many points of view important observations
of the author. His views of digestion are generally speaking highly plausible^
and we are convinced will be found correct when tested by a series of experi-
ments similar to those reported in the essay before us. D. F. C
XVII. Dictionary of Practical Medicine, &c. By James Copland, M. D. Parts
I., II. 8vo. London, 1833-4.
The first and second parts of the Dictionary of Practical Medicine exhibit the
industry, learning, and general talents of Dr. Copland in a very favourable point
of view. In reference to the subjects comprised in these portions of the workj,
he has evidently consulted with considerable care the writings of the most au-
thoritative physicians, whose opinions and experience are stated with accuracy^
18*
210 Bibliographical Notices.
and not unfrequently collated with skill. Whether, however, Dr. C. has always
made the best use of the materials thus collected, and arranged them in the
manner best adapted for easy reference, and for conveying* to his readers an ac-
curate view of the present state of medical knowledge in reference to the seve-
ral topics discussed, are questions which will admit of very considerable dis-
pute.
We confess that we commenced our examination of the work with expecta-
tions which have not by any means been realized. The praises bestowed upon
it by some of the English journals immediately after the appearance of the first
part, and the fact of its being recommended in the strongest terms by one or
two of our leading physicians as a practical treatise, well adapted for the use
of American physicians, led us to believe that we should find it to be throughout
an able digest of the present state of medical science. In this however we have
been disappointed. The dictionary of Dr. Copland is, strictly speaking, a trea-
tise on the causes, symptoms, and treatment of the more prominent diseases of
the human organism, arranged in alphabetical order. Consequently the various
subjects embraced under the heads of anatomy, physiology, materia medica,
pharmacy, obstetrics, and operative surgery are excluded.
The leading doctrines of the day in relation to the correct etiology and pa-
thology of disease, are but slightly touched upon, while the author's own views
in connexion with these important points, are in many instances extremely
vague and unsatisfactory — being rather crude hypotheses than legitimate de-
ductions from well-established facts.
The correctness of this assertion might be established by numerous quotations
from that portion of the work which lies before us; the following however from
the article apoplexy will suffice for the present.
*' A careful consideration of the morbid appearances on dissection, (in apo-
plexy,) in relation to the symptoms, and to analogous changes and their phe-
nomena, have led me to infer that compression of the brain never can take
place; \.\\2it pressure exists in the great majority of cases, but even that it is not
indispensable to the apoplectic state, and that, although retarded circulation,
whether caused by pressure, or by any other state, seems very frequently to
obtain, it does not constitute the only morbid condition of the brain in apoplexy;
or in other words, that apoplexy is not merely a disease of the vessels of the
brain, although these vessels are either consecutively or consentaneously af-
fected."
** The circulation of the brain, like that of other important organs, is chiefly
under the dominion of that portion of the ganglial system of nerves which is
ramified on its blood-vessels, and is distributed otherwise to the organ itself,
and an exhausted or morbidly depressed state of the influence those nerves
exert on the circulation and manifestations of the brain, with the consequentt
effect this state has upon the capillaries, particularly in dilating or congesting
them, and disposing to their rupture, is the principal cause of, and often con-
stitutes the apoplectic seizure, whether this influence emanate from their chief
centres, or from the local sources provided for the peculiar offices of the organ,
as the pineal and pituitary glands."
" From this it may be inferred, that the proximate cause of a large propor-
tion of the cases of apoplexy, not omitting even those which are attended with
retarded circulation and hzemorrhage, is here imputed primarily to the condi-
tion of that part of the ganglia! system, which supphes the blood-vessels of the
brain and the brain itself. That this actually is the case, is shown (how?) by the
nature and mode of operation of the remote causes of the disease; by the foe-
Copland's Dictionary of Practical Medicine, Sfc. 211
quent affection of the functions of the brain previous to an attack; by the nature
of the principal part of the phenomena accompanying- the attack? by the
disorders observed subsequently, when partial recovery takes place; by the ten-
dency to relapse, and by the morbid appearances which present themselves
on the dissection of fatal cases."
*' That a congested state of the vessels and retarded circulation of the brain
should exist, owing to the diminished or exhausted, or suppressed state of that
influence which undoubtedly actuates the vessels, may readily be conceded; but
that even in the brain the effusion of a small portion of blood should occasion
pressure sufficient to interrupt the circulation through it, requires further proof.
It seems more probable and consonant with facts observed in other parts of the
body, that in cases where the extent of effusion or external injury warrant the
admission of pressure, this state gives rise to the apoplectic seizure, as muck
from the effects it produces upon the ganglial apparatus of the encephalon, as
from interrupted circulation through its vessels."
"The neqwQwt inflammatory character oi apoplexy, or the common occur-
rence of reaction, will be readily accounted for, from what has now been stated,
for whether the attack commences with dilatation, or increased action of the
arterial capillaries, or with exhaustion or deficiency of their vital power, or with
retardation of the circulation through the brain and venous capillaries, the re-
sult will generally be augmented action of the arteries going to the brain, ex-
tending itself in some manner to the heart, and this state will continue until the
abolition of the cerebral functions shall have impaired, or otherwise destroyed
the heart's action."
" When apoplexy proceeds from causes of an oh\\o\is\y exciting nature, cr
from sur-action of the heart and arteries, it seldom occurs until a certain degree
of exhaustion of the vital tone of the capillaries has taken place, whereby they
become dilated and congested, so as either to press the encephalon against its
unyielding case, and owing to the pressure, impede the return of blood by the
veins, or to give rise to extravasation, which, when considerable, has a similar
effect; injection of the arteries of the brain and its membranes resulting eq?.ially
from both, owing to the obstructed circulation through the veins."
** There are cases of apoplexy generally presenting the phenomena which
have given rise to the appellation of weak apoplexy, which, occurring from de-
pressing causes, operating upon exhausted states of the encephalon and frame
generally, directly suppress or abolish the vital influence of the organic or
ganglial nerves of the brain, and consequently the cerebral functions, without
producing further change of its vascular system than retarded circulation to so
slight a degree as not to amount to great distention and compression, and with-
out occasioning extravasation of blood, although extravasation often does super-
vene to this state, giving rise to pressure and its consequences, so as to heighten
or prolong the primary lesion, and to occasion paralysis."
It is not our intention to enter upon a formal review of the several articles
comprised in the first and second parts of Dr. Copland's dictionary; neither do
we pretend to deny the correctness of the author's pathological views in rela-
tion to apoplexy as set forth in the above quotations; we merely present them
to our readers, who, however much they may be pleased with the apparent
simplicity of those views, must nevertheless receive them as a mere hypothesis^
in the establishment of which, the author has not adduced any striking fact or
argument.
The following sentence from the article debility, will show the nature of the
leading error in the pathological reasoning of Dr. Copland, and one which has,
in too many instances, extended its prejudicial influence to his practice.
« Debility is a state of vital manifestation intimately connected with the nature
212 Bibliographical Notices.
of disease; and, in whatever acceptation it may be understood, it has been ad-
mitted by every physician who has looked beyond the proper and more palpa-
ble changes superinduced in the economy, as not only a most important patho-
logical condition, but as often constituting what is, in the common language of
medicine, disease itself."
Debility, (diminished vital energy,) produced either directly or indirectly, is
made by Dr. Copland to play a most important part in the production of the
various groups of morbid phenomena, constituting the diseases of the nosolo-
gical writers. We need not wonder, therefore, that the author's therapeutical
directions should have for their primary and most important object the removal
of that debility with which he conceives all diseases, when it does not consti-
tute their very essence, to be so intimately connected. The author is in fact
more liberal in the employment of stimulants and tonics than most other
English physicians of the present day. Even in apoplexy, while he admits the
importance and necessity of venesection and other means of direct depletion
when the case is one marked by a flushed face, full and strong pulsation of the
carotids, and other striking symptoms of undue determination to the brain, yet
in what he denominates weak apoplexy ^ or that very frequent form of the dis-
ease in which the countenance is sunk, the head cool, and the action of the
carotids weaker than natural, he forbids the abstraction of blood as well during
the premonitory stage of the attack as after the apoplectic seizure has taken
place and directs an immediate resort to restoratives, antispasmodics, tonics,
and stimulants. Some of the remedies directed during the apoplectic fit, are
camphor, ammonia, ether, and compound tincture of lavender.
Catarrh according to Dr. C. consists in a specific irritation of the mucous
surface of the nostrils, extending to the frontal sinuses and eyes, the posterior
nares, fauces and throat, and occasionally to the pharynx, oesophagus, glottis
and trachea. While the disease is limited to the cephalic mucous surfaces, he
directs a judicious exhibition of stimulants. Even after pectoral symptoms have
appeared, in some constitutions, he declares, that little or no risk will be in-
curred of inducing inflammatory action by the same measures.
In diff'usive inflammation of the cellular tissue •' however great," he ob-
serves, *'the severity of the pain, or the sensorial excitement; or however fre-
quent, open, sharp, or bounding the pulse; these symptoms should be argu-
ments against, rather than in favour of venesection."
Dr. Copland appears, indeed, to have a most decided aversion to the lancet.
It is true, in many instances he directs in general terms the employment of ac-
tive depletion by the lancet, and under precisely the same circumstances in
which it would be resorted to by our own physicians; but when he enters into
details his active depletion will be found to be restricted to the abstraction of
a few ounces of blood in the early stage of the case; while even the taking
away of this trifling quantity is surrounded by so many minute precautions that
we are persuaded whoever should adopt the work before us as his manual,
would most assuredly become an irresolute and inefficient practitioner. The
necessity for husbanding the patient's strength, and the danger of inducing
early and dangerous exhaustion, directly or indirectly inculcated by our author,
would unquestionably deter an inexperienced physician from carrying the use
of the lancet to that extent which is so essential, in many of the forms of dis-
Cassanova on the Madar. 213
ease occurring In this country, in order to avoid a protracted illness, or even to
rescue the patient from the grave.
As the Dictionary before us has been strongly recommended to the notice of
American physicians, we extract the following paragraph in order to show the
opinion of the author in regard to the character and professional skill of some
portion of the medical public of this country.
" Although opium should be given (in delirium tremens) in full or decided
doses, combined as stated above, (in from one to three or four grains — the
smaller quantity being repeated twice or thrice, the larger not oftener than
once, and after a longer interval,) it should not be persisted in, unless sufficient
time be allowed to elapse after each dose; for, as Dr. Pearson has observed, if
it does not succeed after its exhibition at first in a decided manner, it increases
the intellectual confusion and danger. Some of the American physicians have
recommended enormous doses of this medicine. Dr. S. Brown gives from ^i. to
§ss., or even more, of laudanum for a dose. Dr. S. Jackson prescribes from ten
to fifteen or even twenty grains of solid opium every two hours; and states,
that four ounces of good laudanum having been given in twelve hours, partly
by mistake, a sound sleep of twenty-four hours' duration, and perfect recovery,
were the result. I am only surprised that the sleep was not that of death. These
are not solitary instances of the extravagance, if not rashness, of some American
practitioners; nor, indeed, has the practice of giving excessive doses of lauda-
num in this affection been limited to them. When we find thirty or forty leeches
ordered to be applied to the throat of a child five or six years old in croup, and
repeated oftener even than once, and the bleeding promoted, should we won-
der that death ensues? Feats of hardihood in medicine are too often the conse-
quence of clerical and practical ignorance,- and they may be allowed to meet
their own reward, as long* as they are not obtruded into the annals of our
science, and thereby set forth to the inexperienced as examples to be followed.
But when this distinction is conferred on them, it becomes tlie duty of those
who record the progress of medicine, to note also, and to oppose, its back-
slidings by the severest reprehensions," C.
i
XVIII. Essai sur le Madar^ fCalotropis Madarii Indico-orientalis,J contenani
PHisioire Naturelle de cette Planter ses proprietes Physiques^ Chimiques et
Medicinales. Par J. N. Cassanova, C:- M. D. &c. &c. Calcutta, 1833. pp.
69. 8vo.
The Madar, or Mudar, as it is termed by Ainslie and Wallich, has long en-
joyed the highest reputation in India as a remedy in leprous and cutaneous affec-
tions. It appears that there are a great number of roots known under this name,
all however derived from different species or varieties of asclepias; that which
is the most esteemed is the Seifide or white Madar. Almost all writers on the
medicinal plants of India have considered this as the root of the Asclepias gigan-
tea, CCalotropisy Brown,) but Dr. Cassanova has shown that this idea is errone-
ous. The proofs he has adduced in support of his assertion, although interest-
ing to the botanist, are of little importance to the physician, as it is evident,
from his own admissions, that the medical properties of the Calotropis gigantea
and the C. madarii are identical. It appears that the madar has also been natu-
ralized in the West Indies, where it enjoys full as much reputation for its cura-
tive powers as in its native country. The part used in medicine is the cortical
214 Bibliographical Notices.
portion of the root deprived of its epidermis. This is of a whitish colour, with
little or no smell, and of a bitter and slightly nauseous taste. From an analysis
of it by our author, it appears that it contains — 1. An extractive substance,
f Madarine, J soluble in alcohol and water, and which is probably its active
principle, 5.00. 2. A resin remarkable for its property of not liquifying" at the
temperature of boiling water, and by its shght solubility in alcohol, 4.00. 3. A
gum probably containing some madarine, 8.00. 4. A large quantity of starch.
5. Albumine. 6. A little fixed oil. 7. Ligneous fibre.
The medicinal properties of the madar are undoubtedly of a high order, and
we have the concurrent testimony of a number of eminent practitioners in sup-
port of its efficacy in the obstinate cutaneous affections of tropical climates.
Mr. Robinson* speaks of it in the most exalted terms in elephantiasis and vene-
real affections; and Mr. Playfairf states that he has found it of the greatest ser-
vice in lepra, hectic fever, &c. in doses of grs. iij. to xii. three times a day, gra-
dually increasing the quantity. Ainslie, however, thinks that the dried milky
juice is possessed of more decided powers.
Dr. Cassanova has given it a more extended trial than any of the above-
mentioned practitioners, and has been fully satisfied of its importance as
a therapeutic agent. He states, that its action is more particularly directed to
the skin, increasing the action of the capillaries and absorbents of that tissue.
When combined with opium it acts as a diaphoretic, and in small doses is ex-
pectorant and tonic. In large doses it causes nausea and vomiting. He has
been very successful in the cure of chronic ulcers by the use of this remedy, in
small doses, three grains twice a day.
It is evident, from all that we can gather on the subject of the madar, that it
is a valuable addition to the materia medica, though not likely to come into use
in this country, as we have an excellent substitute for it in the roots of several
closely allied species of plants, viz. the Asdepias syriaca, and the Apocymum an-
drosasmi folium, and M. cannabinum, all of which possess analogous properties;
the latter especially deserves the attention of practitioners in the same class of
diseases in which the madar has been so successfully employed. The experi-
ments of Dr. Mears and Griscom with this plant show, that in chemical compo-
sition and remedial powers it is almost identical with the Calotropis.
R. E. G.
* Medico-Chimrgieal Transactions, Vol, X, t Ibid, Edinburgh, p. 414,
( 215 )
QUARTERLY PERISCOPE,
FOREIGN INTELLIGENCE.
ANATOMY.
1. Malformation — Msence of Anus — Redo- Vaginal Canal By M. Ricohd.—
I was consulted a few days since, by a g-irl, twenty-two years of age, who re-
quested to be examined, saying- that her lover accused her of having" commu-
nicated to him a blennorrhagia, which was utterly impossible, as she never had
connexion with any other person; she also asserted that she was not made like
other women, and begged me in consequence to pay a little more attention
than common to her case. Having been frequently consulted by many females
on pretended deformities, which consist in nothing more than a slight prolon-
gation perhaps of onenympha, or of the carunculse myrtiformes, I am not in the
habit of attaching much importance to their stories on this subject. The ex-
ternal genital organs did not present any thing remarkable or morbid, and the
speculum was immediately introduced with facility. The parts which embraced
its extremity were perfectly healthy, and did not offer any thing abnormal or
morbid to the eye. However, the depth to which the instrument was carried
without meeting the neck of the uterus began to excite some astonishment,
when a lump of fecal matter was brought into view, simulating to the touch the
OS uteri, and also some grape seeds, which were at first taken for vegetations.
Being now convinced that some malformation existed, as the girl had at first
mentioned, M. Ricord examined the organs of generation with the greatest care,
and found the parts in the following state: the labia majora and minora, the
clitoris and its prepuce were of the regular size, and well formed? the meatus uri-
narius was placed in its accustomed situation, and did not offer any thing par-
ticular; the posterior commissure of the vulva and the fourchette were also in
the normal state; but on examining the perineum, we could discover no trace
of anus; the place which the orifice should naturally occupy was marked by a
brown spot, irregularly radiated, about the size of a shilling, and without any
hair, although the mons veneris and vulva were overshadowed with a great
abundance of this material. The ring of the vulva, which did not present any
carunculae myrtiformes, was furnished with eccentric folds formed by the mu-
cous membrane, and engaged a certain power of contraction much less than
that of the sphincter ani, but much more powerful than that of the common
constrictors of the lower part of the vagina. Beyond this vulvar ring the finger
penetrated without causing any uneasiness into a kind of canal, which from its
situation and functions deserved the name of recto-vaginal. The speculum,
which did not produce the least pain when introduced, exposed to the view a
mucous membrane, deprived of those transverse ridges so commonly found in
the vagina; and when pushed on to its full length without meeting the least
216 QUARTERLY PERISCOPE.
prominence or line of demarcation, it was arrested by fecal matter. "When a
finger was placed in this canal, while a female sound was introduced through
the urethra into the bladder, nothing was felt between them except a septum,
which might be compared to the utero-vaginal, or recto-vaginal wall. The
toucher, exercised in every possible direction, and the speculum introduced to
the greatest depth the instrument would permit, did not discover the least trace
of a uterus. Upon questioning the woman with respect to the processes of de-*
fecation, menstruation, and sexual intercourse, M. Ricord discovered the follow^
ing particulars; the fecal matter was always passed by the vulva, and was per-
fectly under the command of volition, but gaseous fluids often escape involun-
tarily: when the fecal matter presented itself at the orifice of the vulvar ring,
she felt a desire to go to stool, and when this desire was satisfied, the finger in--
troduced as deeply as possible, no longer met with any obstacle; the female be-
sides has always taken care to use an injection immediately after, and to v/ash
herself well, by which precaution she always kept herself clean. Menstruation
has never made its appearance under any form, and no trace of blood has ever
been discovered by her in the urine or feces. Although she has lived for three
years with the same man, the latter has never appeared to have suspected or
known the existence of any malformation; the first sexual intercourse which
she had was not accompanied with any pain, for there never was any hymen to
break, and the construction of the vulvar ring was feeble in this young woman.
She feels the desire of sexual intercourse; however, she says, that according to
the account she received from her female friends, her own desires are less
strong, and her enjoyment not so great as in others of her sex. Finally, this
girl is tall, slender, well made, her form and physiognomy are those of the fe-
male; the bosom is well developed, and has never experienced since the age of
puberty any sudden change of volume, her voice is soft and sweet like that of
a female. Before we terminate this observation, the practical and moral con-
sequences of which may be readily deduced, we may notice that in three days
this young female, who was not ill at the time of her first visit, returned with a
urethral blennorrhagia, without any aflfection of the vulva or recto-vaginal
canal.
2. On some points of the Anatomy of the Eye, — Some anatomists have denied
the existence of the conjunctiva upon the cornea; Henle has settled this ques-
tion; he has injected the vessels of the conjunctiva, and observed them to pass
beyond the border of the cornea. That part of the conjunctiva which is at-
tached to the cornea is considered as a serous membrane by Arnold, and that
which covers the sclerotica, according to the same writer, constitutes the tran-
sition of the mucous to the serous tissues.
The sclerotica and cornea are continued one into the other, at least in part,
according to Fraenzel and Arnold. The latter has not found nerves in the cornea;
but Schelmm has seen them in the eyes of oxen, and in the eyes of a stag; these
nerves arise from the superficial ciliary nerves and dip into the border of the
cornea but cannot be traced further.
Arnold and Fraenzel both agree in considering the choroid as a simple mem-
brane, and in maintaining that its division into two layers is artificial.
Arnold asserts that the iris is a simple membrane, which does not possess
muscular fibres, but is composed solely of nerves and blood-vessels.
Much difference of opinion has existed respecting the termination of the re-
tina. Fr^nzel admits with Zinn that this membrane terminates at the origin of
the ciliary processes by an even and well-defined border. Henle has seen this
termination at half a line from the zone of Zinn; whilst Arnold maintains that
the retina lines the ciliary processes, and terminates like them at the border of
the crystalline capsule. Finally, Huschke asserts that the retina covers the cili-
ary processes, and terminates with the choroid at the origin of the iris. The
central foramen of the retina has been but rarely seen by these different ana-
Jlnatom^. 217
tomisfs; but the fold of the retina has always been observed, and considered by
Huschke and Stark as the cicatrix of the fissure, which, in the fostus, traverses
all the coats of the eye, but persists longest in the retina. Stark attributes the
yellow spot to a pigment secreted by a vessel of the choroid which penetrates
the retina in this spot to proceed to the vitreous humour.
The ciliary ligament is composed, according to Eble, of a gelatinous substance
contained in a cellular tissue, of vessels, and finally, of nerves, which form in
this ciliary ligament a true plexus, which probably sends filaments to the cili-
ary processes. Ammon and Arnold maintain, on the contrary, that this ligament
is principally formed by cellular tissue, and has not the least analogy with a
ganglion or plexus.
Some anatomists assert that the membrane of Demours, or of the aqueous
humoury after lining the anterior chamber is reflected upon the anterior face of
the iris. Arnold is not of this opinion; he believes that this membrane forms a
closed sac as long as the pupillary membrane exists, and that consequently it
does not cover the urea. Henle combats these two opinions; he contends that
the membrane of the aqueous lines the posterior surface of the cornea, passes
beyond the junction of this last with the sclerotica, and extends some distance
between this latter membrane and the ciliary ligament, without being reflected
upon the iris.
The crystalline capsule is composed, according to Arnold, of two membranes,
of which the exterior is cellular, and abundantly supplied with blood-vessels,
whilst the interior which is serous, has none, but possesses lymphatic vessels.
The blood-vessels of the posterior parietes of the capsule come from the cen-
tral artery of the retina; the anterior parietes receives its own from the vitreous
humour and ciliary processes. Henle, however, has only once found the vessels
in the anterior parietes of the crystalline capsule injected; this was in the fcEtus
of a sheep; these vessels arose from the posterior parietes of the capsule. An
anonymous writer, {Jimmon's Zeitschriff,}i. II. p. 430,) announces a singular
fact, which appears to merit investigation; this author asserts that he has seen
in the foetuses of sheep and sows, branches of the central artery of the retina
ramify in the posterior parietes of the crystalline capsule, afterwards in the an-
terior parietes of this capsule, and finally, anastomose with the venous branches
of the pupillary membrane at the margin of the pupil.
According to Arnold the crystalline lens is composed of capsules, the parietes of
which are formed by lymphatic vessels. Huschke, on the contrary, who has made
numerous microscopic researches into the texture of the crystalline, maintains that
it is fibrous. It results from these researches that in the foetus and in the infant,
the crystalhne is divided into three segments by three fissures ; in each of these seg-
ments the fibres form a curl, {towrbillon^ Wirbel;) as the individual becomes
older the curls subdivide, and new fissures form, which are all directed from the
centre towards the circumference; in adults from 10 to 13 are found. The
number of fibres of the superficial capsule of the crystalline is from 3120 to
4000 in a man of fifty years.
The zone of Zinn is, according to Arnold and Huschke, only a continuation
of the hyaloid membrane; Henle, on the contrary, maintains that the zone of
Zinn cannot be a continuation of either the membrane of Jacob, or of the retina,
since this zone has vessels which come from the choroid. That the two first of
the membranes mentioned have no vessels at all, and that the retina does not
furnish its own to the zone of Zinn; this last assertion is however contested by
the anonymous author above quoted.
Between the different principal coats of the eye modern anatomists have found
membranous lamina, respecting the extent and nature of which anatomists have
not agreed. They are generally considered as serous. Huschke admits the ex-
istence of a serous memhrane between the sclerotica and choroid, and believes
that it is continuous v/ith the membrane of the aqueous humour; another serous or
membrane of Jacob, betv/een the choroid and retina,- and a third, vascular lamina
No. XXVIL— May, 1834. 19
218 QUARTERLY PERISCOPE.
of the retinat between the retina and hyaloid. Arnold and Frsenzel have also
seen the serous membrane which separates the sclerotica from the choroid; the
first terms it the arachnoid of the eye; the latter thinks with Huschke that it
is continuous with the membrane which lines the posterior face of the cornea.
The membrane of Jacob, according- to Arnold, is only a mucilaginous layer
which forms after death. Henle doubts likewise the serous nature of this mem-
brane, which he has never been able to trace as far as the ciliary body, and in
which he cannot discover any vessels. Frsenzel and Ammon, on the contrary, as-
sert, that the membrane of Jacob lines the choroid and ciliary processes, and is
attached to the capsule of the crystalline. This termination is formed, accord-
ing to Ammon, by filaments which extend from the ciliary processes to the ex-
terior face of the crystalline capsule, and constitute what this physician has call-
ed the capsulo-ciliary circle. The pupillary membrap,e has been particularly ex-
amined by Henle. This author has seen that membrane arise, as was first stated
by Uudolphi, from the exterior portion of the iris, and not from the margin of
the pupil; in large eyes the distance from this border to the point where the
membrane arises was a quarter of a line. Contrary to the opinion of J. Cloquet,
Henle has never observed the pupillary membrane tense; but always convex
either anteriorly or posteriorly. He further states that the French anatomist and
Bhimenbach were wrong in denying the existence of the internal arterial cir-
cle of the iris in the foetus. He has also seen some very delicate blood-vessels
in the centre of the pupillary membrane, of which, according to Cloquet, it is
completely deprived. Henle has injected the vessels of the pupillary by the
internal jugular vein, and has also succeeded by the arteries; but he has never
succeeded in injecting the veins after the arteries were injected; the injection
was always effused between the retina and choroid.
This same anatomist believes that he has discovered, with professor MUller,
of Bonn, a new membrane, which he names capsulo-jjupillaryy and which arises
from the same place as the pupillary membrane upon the exterior face of the iris,
folds over the border of the pupil, and proceeds to attach itself to the crystal-
line capsule where the zone of Zinn terminates. Henle states that he has ob-
served this membrane in the foetus of all animals, (sheep, calf, deer, cats,) which
he has dissected, but that he has not found it in the human foetuses, those which
he examined having remained too long in alcohol.
The capsulo-pupillary membrane receives its vessels from the central artery
of the retina, and transmits them to the pupillary membrane, which appears to
be only a continuation of the first membrane. Arnold and the anonymous writer
already quoted, deny the existence of this false membrane; they attribute the
error of Henle to the method he pursued for the discovery of the capsulo-pupil-
lary membrane, a method which consists in opening the posterior chamber of
the sclerotica, and inverting the iris with the pupillary membrane. By this
process a part of the crystalline membrane or of its exterior lamina alone remains
attached to the pupillary membrane, to which the crystalline capsule is always
more or less adherent. The capsulo-pupillary membrane cannot then, according
to these authors, be any thing but a lamina of the crystaUine capsule. — Mrchiv.
Gen. JunCt 1833.
3. Anomaly in the Venous System. — A curious instance of this has been com-
municated to the Anatomical Society of Paris, by M. Petgot. A free commu-
nication existed between the two sides of the median line, between the crural
and iliac veins on the one part, and the umbilical vein, unobliterated, and tlie
vena porta on the other. This communication was established by means of
the abdominal tegumentary veins, which were so enormously enlarged as to
cover in the shape of two vast pyramidal tumours the anterior parietes of the
abdomen. This communication between the iliac vein and the vena porta
formerly noticed by Lieutaud, and more recently by MM. Manec and Meniere,
constitutes a normal state in several reptiles. — Bev. M^d. Feb. and Mayt 1833.
Physiology. 219
PHYSIOLOGY.
4. Tubercles Developed in the Origins of the Thirds Fifth, Seventh, and Eighth
Nerves — loss of Hearings Sight, and Smell — Preservation of the Sense of Taste, and
of the Sensibility of the Integuments of the Face. By M. Nelaton. — Feret, a girl,
twenty-one years of ag-e, was admitted into the H6tel-Dieu on the 10th of March,
the immoveable expression of her countenance, her projecting and fixed eyes;
and her slow manner of speaking, seemed to indicate the presence of idiotcy in
this female. She complained of constant pain in the head; six years ago she com-
menced to experience these pains, and since that period the sense of hearing
has gradually failed, and within three months she has lost the power of smell.
The sensibility of the skin remained unaffected, both on the face and rest of
the body. Voluntary motion was freely exercised on both sides with vigour;
the sense of hearing was nearly lost; the voice, which had become feeble when
she first entered the hospital, was soon lost altogether; when the point of a
stilet was moved along the surface of the ocular conjunctiva, it did not excite
the least mark of sensibility, although the membrane was dry, and evidently
much inflamed. The whole surface of the nasal fossae might also be touched
with a stilet introduced into the nostril, without the patient being conscious of
it; ammoniacal paste, when placed under the nostril, seemed at first to produce
no effect, but in a few moments excited efforts to cough. The peculiar sense
of the tongue was however unimpaired, for the patient recognised salt when
placed in tlie mouth; the general sensibility of the tongue was also unaffected,
and the gums were in a healthy condition. The patient died suddenly on the
3d of May. On the examination of the body, the middle portion of the brain
and the medulla oblongata were found much developed; the olfactory and optic
nerves did not present any morbid appearance during their whole course; the
fourth pair of nerves, the external ocular motor of the leftside; the glosso-
pharyngeal and hypoglossal nerves seemed also free from any lesion; but all the
other nerves of the brain were increased to at least three times their natural
volume; small spheroidal tumours, of two or three lines in diameter, were de-
veloped in the interior of the nervous chords, or attached to their sides. Some
of these tumours were perfectly well defined, though without cysts, and others
were irregular in their forms. They were all formed by a yellow opaque matter,
similar to that which is found in the centre of tubercles imperfectly softened,
and the nerve itself suddenly contracted in size, after having traversed this tu-
bercular mass. The two common motor nerves of the eye were implanted on
the summit of a cone formed by this substance, which was also found in the
fifth nerve on both sides, but at variable distances from their point of origin; a
small tubercle, half a line in diameter, was attached to the origin of the exter-
nal motor nerve of the right side, but the greater part of the nervous filaments
passed above it, and were not altered. The seventh nerve was diseased from
its origin to the bottom of the meatus auditorius internus; the pneumogastric
nerve was also diseased in the same manner, for the extent of an inch below its
exit from the foramen lacerum posterius; the optic and olfactory nerves did not
present any morbid change of structure in their whole extent. — Lancet.
5. Functions of the Lingual Nerves.— MM. Choist and Montault, have
communicated to the Anatomical Society of Paris, a case which throws consi-
derable light upon the functions of the different nerves of the tongue. A man,
thirty-three years of age, had paralysis with atrophy of the left side of the
tongue; the sense of taste remained unaffected on both sides. The patient
died with symptoms of compression of the superior portion of the spinal mar-
row. On post mortem examination, the muscles of the tongue on the left side
only were found atrophied, and the corresponding hypoglossal nerve. The
atrophy of the nerve extended to the place of its exit from the cranium, where
it was compressed by hydatids. Some hydatids were also found around the
220 QUARTERLY PERISCOPE.
superior portion of the spinal marrow, the functions of which they impeded.
The ling-ual nerve was normal; the left glosso-pharyng-eal appeared to have
been compressed — the patient towards the close of life had had paralysis of the
organs of deglutition. — Hev. Med. February and March, 1833.
6. Instance of Superfcetation. — A married woman, aged twenty-two, was
delivered January 25th, 1832, in the Lying-in Hospital, at Berlin, of twins.
The children were both girls, and died in two hours after birth; their birth
took place before the end of the seventh month from the date of pregnancy.
One child was white, the other evidently a half caste, as was indicated by the
shape of its head, and by the colour of its face, hands and feet, which resem-
bled that of persons who have been tinged by taking nitrate of silver in large
doses. The same difference of colour was strikingly evident in the umbilical
cords of the infants! but not in the membranes of the placenta. On inquiry it
appeared that she was in habits of intimacy with a negro, shortly after or at the
time she had conceived by her husband.— i}MZ;/m Journal, Hecher's Annales.
7. Life and Respiration continued After the total Destruction of the Brain. —
A deformed woman was delivered with the crotchet in 1828. In 1830, she
again became pregnant, and it was resolved after fruitless trials with the for-
ceps to effect delivery by destroying the child's head. Doctor Beyer perform-
ed this operation, took away both parietal bones, entirely emptied the cranium
of brain, and then extracted the infant, which was wrapped in a towel, and
laid near the stove. Dr. B. being engaged in endeavouring to extract the
after birth, heard a sort of wimpering issue from the place where the child lay.
In about three minutes the child uttered a distinct cry, when Dr. B. opened
the cloth, and was astonished beyond measure at finding the brainless infant
breathing, and moving both hands and feet; an occasional cry, and the other
signs of life continued for several minutes, when the infant at last died. — Ibid.
PATHOLOGY.
8. Case of Armmia of the Kidney. By James Wtistn, Esq. — The following case
of anoemia of the kidney lately came under my observation, and was remarkable
from the circumstance of its not having presented any symptoms, which could
have led to a suspicion of the organic changes which must have been going on
for a considerable time previous to death.
January 13th. J. B., aged 50, a weaver. There is extensive oedema of the
trunk, face, and limbs, and particularly of the scrotum, which measures sixteen
inches in circumference. States that he had been labouring under more or less
cEdema of the legs for three years, but that it was only within the last three
months that the swelHng of the belly and scrotum appeared. The principal
symptoms which attracted attention were the universal anasarca above mention-
ed, increased action of the heart, accompanied with bellows murmur, and very
loud bronchial respiration in the upper and anterior portion of the left lung.
These symptoms continued with very little alteration, excepting some diminu-
tion of the swelling of the scrotum from the use of elaterium, for about a week,
when attention was directed to the state of the urethra, on account of his com-
plaining of making water very frequently in small quantities, and attended with
difficulty and pain in passing it. Upon attempting to introduce a catheter, a
stricture was discovered near tlie bulb of the urethra. By the use of the cathe-
ter, leeching, &,c. he was enabled to make water a little freer, and with less
pain, but this amelioration was of short duration. Vomiting, of a grayish fluid,
came on a few days afterwards, accompanied with extreme debility, and which
symptoms continued with little intermission until his death, which took place
shortly afterwards.
Pathology, 221
Necrotomic examination — Chest- — Left ventricle of the heart considerably hy-
pertrophied without dilatation, and a similar state of the right, but not to so
great an extent. Lungs gorged with serum, and the upper portion of the left
lung considerably advanced in the first stage of hepatization. Abdomen — Peri-
toneum contained about six ounces of fluid. Liver, stomach, spleen, and intes-
tines, apparently quite healthy. Both kidneys were of an unusually pale colour,
and upon making incisions through them, their cortical portions were found to
have degenerated into a fibro-cartilaginous substance of a pale-yellow colour;
the tubular portions were quite sound, excepting one or two points where a few
of the uriniferous tubes appeared to have taken on the same diseased action.
Mucous membranes of the calyces and pelvis were of a natural consistence, and
no where injected. Bladder very much contracted, and contained a small quan-
tity of turbid urine; sub-mucous cellular tissue indurated and thickened to the
extent of a quarter of an inch; mucous membrane very much injected, but of
the natural consistence. Prostate gland — texture quite natural, size normal —
a firm old stricture was discovered in the membranous portion of the urethra,
and the remains of a false passage. — Head not examined.
Remarks. — This case, as thousands of others have done, proves the fallabillty
of general signs, and the superiority of physical, as shown by the appearances
found in the chest, and those in the abdomen. The former were indicated be-
fore death, but the affection of the kidneys presented no signs, by which any
notion could have been formed respecting the nature of the lesions discovered
on inspection. It is satisfactory, however, to learn, that even if the precise na-
ture of the disease could have been discovered, medicine would have been of
little avail, at least when the structure of the kidneys had become so extensively
diseased as it must have been at the time he applied for medical assistance; al-
though, it is probable, the disease might have been arrested, could it have been
discovered and properly treated at the outset. The original cause of this affec-
tion I consider to have been the Jiabitual dysuria produced by the stricture, and
which ultimately led to atrophy of the kidneys from the mechanical impediment
it must necessarily have caused to the functions of those organs. That the le-
sions were owing to ancemia and not irritation, I think probable, from the cir-
cumstance of the mucous membrane and tubular portion of the kidneys being
quite healthy, whilst the secerning portions v/ere perfectly bloodless. — Glasgow
Med. Journ. April, 1833.
9. Case of Hypertrophy of the Muscular Coat of the Stomach. — Dr. Otto, of
Annaberg in Saxony, relates in Huf eland's Journal, for Feburary, 1833, an in-
teresting case of hypertrophy of the muscular coat of the stomach, a pathologi-
cal condition of rare occurrence. Morgagni, Haller, Baillie, do not mention it.
Meckel in his PathologicaJ Anatomy, only observes in a general manner, that
the parietes, especially the muscular coat of the stomach of great eaters, are
thick. Beclard in his additions to Bichat's General Anatomy, does not notice
this kind of hypertrophy, and speaks only of that of the heart and bladder.
Louis has noticed this subject more particularly than any other French writer,
in his Anatomico-pathological Researches. When treating of cancer of tlie
pylorus, he quotes two cases of hypertrophy of the muscular coat of the sto-
mach, which he compares to the parietes of the ventricles of the heart, the
fasciculi were prominent; in both cases there was scirrhus of the pylorus, and M
Louis proposed the question, whether the contraction of the duodenal orifice
of the stomach was the cause of the hypertrophy. In the following case there
was neither scirrhus nor contraction of the pylorus, and the opinion of M. Louis
that these two diseases are independent on account of the frequency of the one
and the rarity of the other, is confirmed.
A woman, forty-nine years of age, thin, sanguineous temperament, mother
of several children, had experienced many domestic troubles, from w^hich she
endeavoured to distract her mind, by indulging her appetite for eating, which
became incredibly voracious. In the summer of 1827', she complained of pe-
19*
222
QUARTERLY PERISCOPE.
riodical dyspnoea, and swelling of the right foot? her menses ceased; she he-
came emaciated; her appearance was that of a person in bad health. Never-
theless, she had no tumefaction of the abdomen, nor pain there on pressure;
her appetite was good; evacuations regular; tongue clean, and she never com-
plained of nausea, borborygmy, hiccup, or laborious digestion. The respiration
was easy, pulsation of the heart feeble, the pulse normal. She was remarkably
depressed in spirits. The predominant symptom consisted in a periodical
dyspnoea, which recurred every evening, sometimes even during the night, and
produced a sensation of weight in the lower part of the abdomen, which rose
up like a ball towards the heart, and impeded her breathing. These symptoms
continued for six or eight minutes, and always a long time subsequent to a meal.
Their intensity became so great, that the patient was at times delirious; she
even at one time attempted to hang herself. At the commencement of winter
the emaciation made alarming progress, without the appetite being diminished,
or the digestion deranged, and although the patient was so enfeebled, that she
could not quit her bed. The violence of the paroxysms constantly increased;
the marasmus took place, with subsultus tendinum, weakness of the organs of
sense, coma, loss of sensibility, delirium, and finally, death on the 19th of De-
cember, 1827.
Autopsy^ ten hours after death. — The pectoral organs were healthy; the heart
small; the pericardium contained a little serosity; omentum wanting; liver and
spleen normal; stomach shrivelled and thickened, especially towards the pylo-
ric region, and along the larger curvature, which appeared less extended than
the smaller; its blood-vessels empty; its mucous membrane thin, almost trans-
lucent, ordinary consistence, covered with a viscid and thick mucus, elevated
by numerous muscular fasciculi, the size of a goose-quill, the direction of which
was from the great cul-de-sac to the pylorus. These gave to the internal face
of the stomach the appearance of that of the heart. Beneath these fasciculi
the muscular coat formed a layer of half an inch in thickness. The remainder
of the intestinal canal was in a normal state, as were also the urinary passages.
This case is interesting in a double point of view; 1, in a pathological aspect,
connecting the stomach with other muscular sacs; 2, by the almost total absence
of symptoms referrible to the digestive organs. — Rev. Mid. Aug. 1833.
10. Observations on Epidemic Gastric Fever, as it appeared in Limerick Garri-
son during the months of May, June, and July, 1833. By Richard Podie, Esq.
Assistant-Surgeon 32d Regiment. — Affections of the alimentary canal were the
prevailing disorders in the 32d Reserve,, during the period of its being quar-
tered in Limerick; but it was not until the subsidence of the influenza, that any
examples of gastric fever made their appearance. Before this, one or two spo-
radic cases of an inflammatory type had occurred; but in these no decided evi-
dence of gastro-enteric character existed. Besides, as the treatment, appa-
rently the best adapted for these, would have had less beneficial effects in the
complication mentioned, it is but fair to infer, that the alimentary canal was
not the seat of any lesion that could have influenced their character; and it is
singular, too, that, even during the time cholera existed in the garrison, some
fevers, without any gastric complication, made their appearance.
Be it remarked, then, it was not until the influenza had existed for some
time, and was on the decline, that a change in the type of the fever was ob-
servable; and that it is from this period I date the commencement of the epi-
demic which it will be my task in the following pages to describe.
It is not necessary for me to mention here the frequent instances on record
of gastro-enteric fever, and diseases following the march of this singular affec-
tion. They are well known to most of the older practitioners who have paid
any attention to epidemic constitution, and are amply detailed in the article
Influenza published in the Cyclopaedia of Medicine, to which I refer. It is
equally unnecessary for me to give the rationale of their connexion. This must
strike any one who considers the similarity of the textures concerned, especially
Pathology. 223
as, of late, attention has been much paid to the sympathies existing" between
the two membranes, and to the faciUty with which disease in the one is ex-
tended to the other. The article on Epidemic Gastric Fever by Dr. Cheyne,
in the work alluded to, is a valuable summary of most of the facts connected
with the disease; and nothing would induce me to go over nearly the same
ground, but the wish to adduce further testimony to the truths it contains, —
and some anxiety to impress upon the attention of my professional brethren in
this country, the necessity of admitting the existence of a class of diseases
which requires a plan of treatment very different from any promulgated by the
authorities on whom they have been long in the habit of placing exclusive re-
liance.
That the disease in question depends upon a lesion of the gastro-enteric
mucous surface, I conceive to be as probable as the connexion between pneu'
monia and its symptomatic fever; and, although I cannot bring forward necros-
copic appearances to elucidate the position, — none of the cases having proved
fatal, — [ consider the relative proofs so strong, that I do not hesitate in giving
to the disease the name here fixed, — believing that, under this, it is deserving
of a place in any system of nosology founded on a pathological basis. Its simi-
larity to the disease described by Dr. Cheyne, who gives several dissections,
is further evidence of the correctness of this view.
Most of the cases which came under my observation presented, before the
disease was unequivocally developed, considerable general disturbance, but by
no means of a nature to excite apprehension of its invariable results, — being
confined in a great measure to lassitude and prostration, — the patients com-
plaining of general uneasiness, without being able to point out one sensation
more uncomfortable than another. They were heavy, dull, and listless, — hanging
over the fire, — feeling chilliness at one time, and irregular distribution of heat
afterwards, with loathing of food, and frequent inclination for cold drinks, from
the dry and parched state of the mouth. This was generally greatest in the
morning. The complexion was usually dusky, all trace of sanguification being
gone from the cheeks, and often from the lips. These disagreeable symptoms last-
ed for several days, and were soon followed by the development of fever, which
was most complete towards night. The pulse averaged at 110; was sometimes
tense, but generally soft and full. The skin became remarkably dr)^ and harsh;
moisture was never observed on it; and, in some cases, it assumed a degree of
roughness similar to what is observed in chronic affections of the gastro-enteric
organs. The patients became more and more depressed, and were overpower-
ed by an apathy to external objects or ordinary impressions; and, though even
now they scarcely complained, except, perhaps, of weakness, the whole ex-
pression showed amply the extent to which the disease had overcome their
energies. As the fever may be now reckoned at its height, it will be better,
for the purpose of elucidating its nature, to take a view seriatim of the symp-
toms, as referable to their respective localities.
I think it will be proved, in the course of this memoir, that the symptoms
which might be termed cerebral were merely functional or sympathetic; but,
to make the history as complete as possible, I shall mention, in the first place,
all of them that may be attributed to an irritation of the sensorium. The most
remarkable of these was profound torpor. The patient lay without exhibiting
any evidence of intellect remaining, — the eyes were closed, and only sluggish-
ly opened when he was addressed, — a fev/ incoherent words were uttered at
first, and as it were at random, — but presently he became roused, andans\yered
questions as distinctly as the dry state of the mouth would permit. There was
now complete return of consciousness, and the patient described with correct-
ness his situation and feelings. In one case only, a man of the 83d Regiment,
was there total insensibility, with picking the bed-clothes. Some complaijied
of confusion in the head, giddiness when it was raised from the pillow, with
noise and buzzing in the ears. Deafness was also observed. In one, twitchfing
of the lips and slight contortion of the mouth were detected; but these, I think.
224 QUARTERLY PERISCOPE.
were almost entirely occasioned by the intense dryness of the fauces. Pain in
the head was seldom complained of, and certainly was not felt at all by many,
while g-iddiness and beating were often mentioned. The eyes was never in-
jected, but dull and heavy; the cheeks seldom flushed, — the complexion being
generally of an earthy-yellow cast.
All these symptoms, I am induced to believe, were entirely due to sympa-
thetic excitement, and in no case appeared to depend on structural lesion.
They become worthy of some special consideration, with a view to tracing
their dependence on derangement existing in another situation. To this,
however, I shall refer in its proper place.
The chest, examined by the stethoscope, afforded in every case, during the
pyrectic stage, numerous sibilant and sonorous rattles; but I generally found
these disappear, without being followed by others, or any symptoms of bron-
chial disease. In some cases, however, they were attended by cough and ex-
pectoration, but never with pain; and in several I found benefit result from
treating this affection locally, — a fact which I might readily have overlooked,
but for the stethoscopic observation.
From these circumstances, and many others which I need not detail here, I
think the stethoscopic signs deserving of attention, in showing the intensity of
the disease when taken along with the symptoms; but I safely can state, that I
usually considered the former of little importance, when not accompanied by
other evidence of disease, and that 1 never had cause to regret having done so.
Laennec probably carried his views on this point too far, and I hold the pro-
fession indebted to Dr. Graves for having sometime ago drawn their attention
to the subject, and shown the errors into which we may fall by placing too
much reliance on the signs furnished by auscultation during the progress of
certain fevers.
But to proceed. The pectoral symptoms, when they did appear, were never
serious. Some cough, with varied expectoration, might occur in the mornings
but there never was any thing like profuse secretion from the bronchial mem-
brane, and in none of the cases did the parenchyma or its investments suffer.
A gastro-enteritis being, so far as I can determine, the immediate cause of the
phenomena observable in this disease, the symptoms ascribable to the disor-
dered viscera demand the greatest attention. Yet with all this, an observer
might overlook the seat of the whole mischief, and be led to consider a disease
essentially specific, and requiring a distinct plan of treatment, as either of no
importance, or similar to others which he is daily in the habit of meeting. A
most mischievous and absurd blunder about pain at epigastrium, red tongue, &c.
as characterizing gastric complication in different diseases, has been of late
freely promulgated; and one is almost tempted to understand, that inflammatory
affections of the muco-enteric surface have been specially favoured in being
made so palpable to our powers of discrimination. But, however decided igno-
rance may be in its dogmas, any one who has paid attention to the diseases in
question cannot but state, that their symptoms are far from being so glaring,
and, from out of the innumerable variety exhibited, will fail in pointing out any
one or two as pathognomonic. In none of the numerous disorders produced by
this lesion are the symptoms so varied and obscure as in the one before us; and
it is only from their assemblage, and not from any one in particular, that a diagno-
sis can be made. For example, in not one of the cases did there exist tenderness
at the epigastrium, or any other part of the abdomen. Pain and weight, indeed,
were often felt, but they were by no means constant, and depended most fre-
quently either on distention from wind, or the soreness that attends a loose
state of bowels.
DiarrhcEa invariably ushered in the complaint, and frequently reappeared
during its course; but the bowels were at other times slow, and required to be
unloaded. Every medicine in this way, however, required to be of the mildest
nature, as even the gentlest laxative produced often violent effects. The fecal
discharges were variedj— in .some they appeared wholly serous or mucous} in
Pathology, 225
others natural, but liquid. Various intermixtures of colouring matter were fre-
quent;— in some blood; in others bile; and, in a case in the 83d Regiment, what
might be termed maelena. In this case, large quantities of calomel and Cayenne
pepper had been given by a practitioner in the country, who, fortunately for
the patient, considered his case bad enough to have him removed to head-quar-
ters. Griping was a frequent attendant, but tenesmus was not observed. Vo-
miting o^ bilious looMng matter occurred in one case; but the stomach was ge-
nerally retentive, though nausea was by no means unfrequent. Complete ano-
rexia existed for many days. The patient obstinately refused to eat any thing, —
appearing to loathe the sight of food, or the idea of using it.
Thirst was incessant, cold drinks being greedily asked for, and relished;
whereas any thing warm was as much an object of aversion as food. The
mouth for many days was dried up, and parched to a remarkable degree; the
fauces, gums, and tongue were red and glazed, as if covered with gold-beater's
skin; the latter, during the course of the fever, became hard, dry and chopped,
enveloped with a firm dark brown or black fur, and bleeding from its numerous
fissures, when protruded from the mouth, which was done often, only with
difficulty. This state of the tongue was very constant, and lasted until the
fever was on the decline. The dryness of the fauces, as I mentioned before,
was the cause of the deficient power of enunciating which existed in all the
cases. I was led at first, however, to look upon it in another and more serious
light.
To the state of the stomach and bowels must also be referred the constant
prostration and feeling of languor and helplessness which characterized the at-
tack; and I cannot but believe, that the torpor observed in many was but a
high degree of this feature. The value of determining the point can only be
appreciated by taking into consideration the readiness with which it may be
confounded with coma, and attributed to structural derangement of the brain,
or its membranes. In two of the cases in which it was most evident, a man of
my own corps, and one of the 83d Regiment, in which it was attended with
involuntary discharge of faeces, total insensibility, picking the bed-clothes, and
other ataxic symptoms, it was entirely removed by copious leeching of the ab-
domen, and cold drinks, — with small doses of .Acet. Morph. in the latter case;
in which, had it been occasioned by sensorial lesion, it would surely have been
increased by the opiate. In the former case, the assumed debility and prostra-
tion were so intense, that the patient could scarcely turn in bed. Yet, after
the second or third leeching, he recovered so much, that, on awaking from
sleep, and probably dreaming of other days, he got out of bed, put on his
clothes, walked down stairs, and was found at the door of the hospital by the
hospital' sergeant, whom he told he was going by my leave to visit his mother
in an adjoining county.
These facts, with others which I need not detail here, serve to show that
prostration and torpor are but shades of the same disorder; and that, whenever
they exist, we are warranted in believing the gastro-enteric surface the seat of
more or less inflammatory action. They are, however, by no means new,
having been brought before the profession some time ago by M. Broussais,
since confirmed by the researclies of Andral, and, if less known in this country
than they deserve, which I think scarcely admits of a question, it is the fault
of a few to whom for a long time a blind deference has been paid by the mass of
practitioners. This, however, is not the place for a discussion of the subject.
The duration of the stage, characterized by the preceding symptoms, varied,
of course, in different cases, but on an average, may be stated to have lasted,
from a week to ten days. In all of them was observed great tendency to mut-
tering during sleep; and several of the patients got up while asleep, and at-
tempted to leave their wards. The pulse varied but little, either in frequency
or force,— being often for days 130, but seldom under 100. In this fever, no
critical discharges were ever observed; the symptoms gradually declined in S8»
226 QUARTERLY PERISCOPE.
verity; the skin became softer and cooler during the day, hut evening acces-
sions were observed for some time afterwards; the tongue got daily more moist, —
the dry patches disappearing, and being replaced by a creamy deposit, which
I always looked upon as the harbinger of recovery. In some cases, this became
dry and scaly, from some fresh irritation; but in some of them it slowly went
off, leaving the tongue remarkably white, and as it were firmer and closer,
from being decreased in volume. The thirst abating, some appetite was felt;
but it was never craving or vocarious, and was readily satisfied by light farina-
ceous diet, which the patient invariably relished mere than any other that was
offered. The cough generally went off about the same time; the bowels be-
came easy and regular, and seldom required during recovery, assistance from
medicine. Convalescence was tedious and protracted, but in no case was there
any relapse.
The duration of the attack averaged from five weeks to two months. As I
stated before, no death occurred in any of the cases that came under my ob-
servation, which included a squadron of dragoons, the 32d Reserve, and 83d
Regiment; but I was given to understand that the son of an officer belonging to
another corps sank under a protracted attack. Some cases of fever of a like
character prevailed in town; but 1 cannot state any thing concerning their pro-
gress or termination.
Treatment. — General bleeding was adopted in several cases at the commence-
ment, with a view to cut short the disease by making an impression on the sys-
tem, and to pave the way for local depletion; but I cannot state that in any it
appeared to fulfil the intention. In no case, however, did it seem to do harm,
as the quantity abstracted was never great. My conviction is, it might have
been safely dispensed with in all, as the phkgmasise of mucous membranes, and
especially of the enteric, appear to be little under the influence of the general
circulation, and few of them ever excite any violent action of the heart, which
demands the use of this remedy. But for all this, cases often occur in which
the general excitation is great, and in these, general depletion is undoubtedly
required, as the attempt to unload the capillaries must be always futile when
the centre of circulation continues over-active. I might digress here to some
length, as the subject is an interesting one; but the object of this memoir being
merely to describe facts and occurrences, any thing like discussion is contra-
indicated.
Suffice it to say then, that none of the cases exhibited any great vascular ex-
citeraent, and that the general bleeding was perhaps used more from specula-
tion than cogent reason. Local depletion was in all of my own cases freely
used when the disease was pronounced, and different parts of the abdomen
were at times selected for this purpose. When much diarrhoea existed, the
position of the lower end of the ileum and course of the colon was chosen, —
the region of the duodenum in one, in which there was much yellowness of the
skin and conjunctivae,- and in most of them, at one time or another, the epigas-
trium^ without being demanded by any of what have been looked upon as spe-
cific gastric symptoms. Leeches were always used, as cupping is generally
more irksome to the patient, and frequently a less efficacious means of procur-
ing blood. From this remedy the best effects were produced, — in most of the
cases a marked improvement following each application. The extent to which
it was carried was regulated of course by the demand. In some cases, as of
men belonging to other corps, in whom the treatment had been conducted from
the beginning on different principles, and who presented the worst symptoms
observed in the disease, copious leeching was invariably followed by an almost
immediate change for the better, and it was from this period alone that the re-
covery might be dated. I can therefore safely state, that, on this remedy, I
chiefly depended as a means of reducing the local affection, after which the
progress of recovery was uninterrupted.
Different counter-irritants were likewise applied to the abdomen, as emetic
Pathology, 2;^?
tartar ointment, any of the ethers, turpentine, &c. the former frequently with
good effects in restraining diarrhoea, and the others in reUeving the sensations
of uneasiness complained of.
Counter-irritation on the chest was freely used during the existence of the
pectoral symptoms. Tepid and even cold sponging was plentifully used, and
always produced grateful and salutary effects. The loose state of the bowels
at the commencement precluded every thing in the form of purgative; but
during the course of the disease, attention was paid to procuring daily evacua-
tions by laxatives or enemata. This affection, as Dr. Cheyne truly observes, is
not a fever that requires any thing like a purgative plan of treatment, — all that
is demanded being merely the emptying the contents of the canal, which is to
be done only by the mildest remedies.
As adjuncts to local bleeding, in allaying the irritation of the membrane, and
quieting the different uneasy sensations that occurred, I found many of the se-
dative medicines beneficial, and when used with caution and due regard to the
condition of the patient, I can safely say, that even under circumstances which
might be accounted as contraindicating their employment, they always ap-
peared to me to be followed by excellent effects. The medicines of this class
chiefly used were hyoscyamus, or the acetate of morphia. The former, in al-
most every stage of the disease, produced quietness and relief to the local pain;
it in some instances gently moved the bowels, and frequently in full doses pro-
duced a quiet night's rest, without being followed by disagreeable sensations
next morning. Combined with any of the gum solutions, but especially the
tragacanth, it formed an excellent lenitus for allaying the cough, and even in
this form, appeared often to relieve the irritation attending the diarrhcea. The
morphia was used in several severe cases in the 83d Regiment, even under the
worst of the cerebral symptoms, with good effects, and in no instance appeared
to increase them. I used it in several cases in the 32d Regiment, and found
that it frequently procured good nights without any bad effects; but in others,
observing the tongue in the morning more parched, I was naturally led to sub-
stitute for it the hyoscyamus, which never occasioned any change in the secre-
tions. In advanced cases, it answered better, particularly if there was trouble-
some diarrhoea.
During the whole course of the fever, the patients drank freely of cold aci-
dulated mucilages, which reheved their thirst in a way most grateful to their
feelings. During the first week or fortnight, abstinence was both enjoined and
vohmtary; but, on the return of the appetite, mild farinaceous diet was allowed,
and the patients by degrees, as the fever declined, returned to the use of more
nourishing food. In some, a little wine or malt liquor was allowed during con*
valescence; but they were not generally required.
1 may conclude by saying, that the treatment adopted, with the exception of
the depletory measures, was essentially expectant; — in fact, there were but
few symptoms to combat, and I took care, as far as possible, to develope no
new ones, — a care, in which, as there never appeared any of those alarming
and sudden phenomena so pecuharly observed under different circumstances,
I have some cause to believe I succeeded. — Edin. Med. and Surg. Journ,
January y 1834.
11. Paraplegia Dependent on Chronic Inflammation of the Spinal Cord. — Dr.
Craigie has recorded the following interesting case of this affection in our es-
teemed cotemporary, the Edinburgh Medical and Surgical Journal^ for January
last. This case occurred in an unmarried female, thirty-five years of age, who
had been in hospital about twelve months previously, with symptoms of hemi-
plegia, which had partially disappeared after treatment of some weeks' dura-
tion, but left a degree of inability to walk, in consequence of an involuntary
spasmodic contraction of the flexor muscles of the thigh. Some months after
she complained of a sense of weakness, and constriction referred to the lumbar
region; and about a month before admission, fi. e. about the 25th February,
228 QUARTERLTT PERISCOPE.
1833,) she began to complain of inability to move the left lowef extremity
without dragg-ing it, and a sense of numbness from the lumbar region down-
wards, and also in the left iliac region. At the period of admission on the 25th
March, she complained much of the involuntary spasmodic traction of the
flexor muscles, which, with a sense of painful distention round the belly, was
so considerable, as to disturb her nights and prevent sleep. The appetite was
stated to be good, the general health not affected. The pulse, however, was
from 80 to 90, the skin hot and dry, and the tongue covered with a brown dry
fur. The intellectual functions were unimpaired, and the urine and feces pass-
ed naturally. The whole vertebral column bore pressure and warmth without
uneasiness; and there was no deformity or change in direction.
As I was convinced, from the symptoms now enumerated, that the spinal
chord or envelopes were the seat of a chronic inflammatory process, I ordered
blood to be drawn from along the course of the dorsal and dorso-lumbar region
of the spine by leeches and cupping, the bowels to be emptied by the com-
pound colocynth pill and calomel, and occasionally by croton oil, aloes, and
calomel.
An attack of shivering, with sickness and vomiting, succeeded by heat, quick
pulse, general pains, and an aggravation of the spasmodic attacks, made me
dread the accession of an acute form of the complaint, and induced me to order
a general blood-letting to the amount of eighteen ounces, to be followed by a
dose of infusion of senna and the saline mixture; and, as the Mood was much
buffed and cupped, and she bore the evacuation well, twelve ounces more
were drawn in the evening; the bowels were freely opened by cathartic medi-
cine, and blood was drawn from the ileo-lumbar region, to which much pain
was referred, by means of leeches. Under the use of these agents she was less
distressed with the spasmodic contractions, and she thought that she had more
command of the lower extremities. Rose, which, however, all this season was
prevalent in the hospital, appeared on the back and belly, and added much to
her sufferings. On the 6th, she complained much of tension and constriction
of the belly, the stools were passed unconsciously, and the bladder had lost its
contractile power, requiring the urine, amounting occasionally to six pounds,
to be withdrawn by the catheter.
These symptoms continued to the 10th, when they were aggravated by the
addition of sickness and vomiting. The muscles of the lower extremity, as well
as the rectum and bladder, did not recover any power; and, after a state of
iistlessness and extreme feebleness, with respiration only at eleven in the
minute, yet without hiccup or insensibility, death took place on the 14th.
On laying open the spinal theca^ there was found effused beneath it a consi-
derable quantity of fluid highly tinged with blood, probably chiefly from di-
vided vessels. Along the whole course of the dorsal vertebra the theca was in-
jected and thickened, especially anteriorly. On dividing the pia mater, part
of the spinal cord, opposite the tenth, eleventh, and twelfth dorsal vertebras
protruded like a hernia cerebri, and it was found to be extremely soft, pulpy,
and of a homogeneous cream colour. This condition of the cord extended up-
wards to the second dorsal vertebra, and dov/nwards to the second lumbar ver-
tebra, diminishing in both directions gradually till it terminated in sound cere-
bral matter. It was most remarkable in the posterior surface, where all trace
oi" organiztition was destroyed, but less so at the anterior surface, excepting at
the spot opposite to the tenth and eleventh dorsal vertebra, where, when re-
moved from the sheath, it was so unable to sustain its own weight that it fell
asunder.
On examining the brain, a considerable quantity of fluid was found effused
under the arachnoid membrane, rendering it opaque. The substance of the
brain was healthy. The ventricles were slightly distended by serous fluid; and
the choroid plexus and the pia mater, at its junction with that web, were re-
markably vascular.
In the chest the right lung was generally adherent. Both were emphyse-
Pathology, 229
matous in some degree anteriorly and inferiorly, and the superior lobes were
hig-hly oedematou-, emitting- frothy serous fluid in considerable quantity on each
incision. The heart was natural in size and structure.
The liver was rather paler and firmer than natural. The other organs were
sound. In this case the pulpy destruction of the spinal cord, which gave rise
to the paraplegic symptoms, arose spontaneously, so far as could be discovered,
or, at least, was unconnected with any disease of the vertebrse. Ti.c theca alone
appeared to be in a state of previous chronic inflammation; but this could not
have been adequate alone to induce the disease of the spinal cord. The arte-
ries also were sound.
12. Case of Myelitic Paraplegia depending upon Disease of the Bodies of the
Vertebrae. — This case is also recorded by Dr. Craigie in the same journal. The
subject of it was a widow, Isabella Meldrum, aged fifty-three, following the oc-
cupation of a washerwoman. About five or six months before, she had fallen
down a flight of stairs, and lighted on her back. This accident attracted little
attention at the time. But about the close of January, 1833, she was afl'ected
by tingling sensations, with numbness in the limbs, while her general health
was enfeebled by dyspeptic symptoms. The tingling sensations continuing,
she was attacked, in the course of two weeks more, by severe pains in the epi-
gastric and right lumbar region, with great general feebleness and partial loss
of motion and sensation of the lower extremities, beginning first in the feet and
toes, and extending upwards. When these symptoms had continued about
two weeks, the feet became oedematous and cold; and constipation was follow-
ed by involuntary discharge of the feces, while the bladder becoming over-dis-
tended, lost its retentive powers. The constant trickling of urine in this manner
had produced large sloughs over the sacrum, while the application of exces-
sive warmth to the insensible skin of the feet had been followed by several bad
sores. In this state she was admitted on the 24th March, with the abdomen
much distended and tympanitic, sensation almost gone below the epigastric
region, the feet and legs cedematous, the temperature rather above natural, the
hypogastric region painful, and the urine incessantly trickling from the bladder.
By the frequent use of the catheter, the bladder recovered much of its power,
and she was made comparatively comfortable. The bowels were opened by
calomel and colocynth, with the aid of occasional enemata; blood was drawn
from the region of the spine by means of leeches; powders consisting of super-
tartrate and nitrate of potass, and carbonate of soda, with aromatic powder,
were given to act on the kidneys; a light but nutritious form of diet was direct-
ed; and to the sloughs on the back and sores on the feet poultices and the warm
dressing, or the resinous ointment, were applied.
Under these measures, I. Meldrum became greatly more comfortable, and re-
covered some sense and motion of the limbs; the urine became copious; the
oedematous swelling of the feet subsided; and the tympanitic sensation of the
abdomen abated. It was very soon observed, however, by the constant weight
and pain in the hypogastric region, with the turbid, clouded, fetid urine, that
she was labouring under catarrhal inflammation of the bladder. The thirst con-
tinued unquenchable, the tongue dry and brown, the pulse never below 112,
and the skin hot and dry; and after lanquishing for two weeks more, notwith-
standing the use of appropriate remedies, with such articles of nourishment and
wine as she could take, she died on the 25th April.
The following appearances were observed.
At least one ounce of serous fluid was found within the tkeca of the spinal
cord. When this was laid completely open, the cord was found pale, and of a
dead white colour, and as soft as thick cream, first at a part corresponding to
the eleventh and twelfth dorsal vertebrae, where it broke down completely, and
was void of organization. Upwards from this the cord was softened as far as
the seventh cervical, and downwards as far as the second lumbar vertebra,- and
through the whole of this extent it was of the consistence of thick cream of a
No. XXVIL— May, 1834, 20
230 QUARTERLY PERISCOPE.
dead white colour, and without marks of fibrous structure. The eleventh and
twelfth dorsal vertebras were on their posterior surface denuded of periosteum^
and presented a quantity of granular matter, on removing" which the cancelli
were exposed and somewhat softened and carious. The intervertebral cartilage,
between the first and second \\xmb-3ivvertebrsc, presented a globular excrescence
about half an inch in diameter, and one-fourth in elevation. There was another
smaller one between the second and third lumbar vertebrae. On opening the
thorax, five of the dorsal vertebrae were found covered on the right side by an
oblong cyst containing pulpy matttr of an atheromatous appearance and con-
sistence. On removing this cyst, the bodies of the vertebrae were found de-
prived of periosteum, and their cancellated texture exposed.
The convolutions of the brain were much softened, and a considerable quan-
tity of serous effusion was found in the sub-arachnoid tissue. The substance of
the brain was softened, and the ventricles contained some serous fluid.
The upper extremity of the left kidney was closely adherent to the diaphragm
and spleen; at the inferior part was an abscess containing tubercular granular
matter, which was found on dissection to communicate with iha pelvis. Several
of the calyces were enlarged, and contained similar matter. The ureter was
dilated and thickened, and its mucous membrane inflamed and roughened on
the surface.
In the right kidney the pelvis was also dilated, and its mucous membrane
thick and roughened. The ureter was also enlarged and thickened.
The coats of the bladder were much thickened, its mucous membrane of a
bluish colour, irregular, and covered with bloody patches. The dimensions of
the bladder were much contracted.
This and the preceding case illustrate remarkably a general fact observed in
the approach of palsy, especially when it depends on a progressively advancing
disease of the central parts of the nervous system. In both, the accession of
the symptoms was marked by painful involuntary spasmodic contractions of the
flexor muscles. This indicated, not that the nerves of the flexor muscles were
most affected, but that those of the extensors were already diseased so far as to
have lost all controul over the muscles. In consequence of this, with the dis-
turbed action at the central ends of the nerves generally, the inherent irrita-
bility of the flexor muscles gives rise to spasmodic contractions. This pheno-
menon is not observed when the injury or disease is so great as to extinguish
suddenly all sensation and motion, but only when it advances so slowly and
progressively as to pass through successive stages to the final result.
13. Case of Periostitis with Ozoena. By David Craigte, M. D. — This case oc-
curred in the person of a woman named Robina Wright, aged twenty-nine, who
had been long known as one who, though not exactly a public female, had
been subjected to repeated courses of mercury. At a former period, syphilis
had produced destruction of the recto-vaginal septum; and she subsequently suf-
fered much from the contraction consequent on cicatrization. At present, (19th
February,) she applied for admission for symptoms of rheumatism; but the pains
mistaken for this disease were evidently the dolores osteocopi, or the deep-seat-
ed aching pain resulting from inflammation of the periosteum of the tibia and of
both parietal bones.
The usual remedies of local depletion and counter-irritation were applied.
Opiates were exhibited, and the warm bath was administered; and, had it not
been for the epidemic prevalence of erysipelas at this time, with the dilapidated
state of the patient's constitution, this woman's sufferings might have been al-
leviated, and the disease retarded in progress.
An obstinate fetid puriforra discharge, however, from the nostrils, with some
tenderness in the situation of the nose, indicated the existence of inflammation
of the periosteum of the bones of the face; and the occurrence of erysipelas, by
aggravating her febrile symptoms, disturbing her sleep, and affecting the brain,
very soon brought her to a state in which medical treatment was of little or no
Pathology. 231
avail. After a combination of low delirium with stupor for four or five days,
succeeding" on the intense swelling" of the face, with symptoms of extreme dif-
ficulty of respiration, tracheo-bronchial rattling, and incapacity to swallow, she
died on the 9th of March, suffocated apparently by the constant accumulation
of mucus from the back part of the nostrils upon the glottis and larynx.
Upon inspecting the body, a great quantity of viscid purulent mucus was
found covering the posterior nasal cavities, the posterior fauces, the glottis, epi-
glottis, a.nd pharynx. The periosteum of the nasal bones, of the upper part of
the superior maxillary bones, where they form the floor of the orbit, and that
of the superior and inferior spongy bones was completely detached, and came
away as if it had been subjected to long maceration or boiling. The periosteum
of all these bones was very much thickened and extremely vascular; and be-
tween it and its respective bones, purulent or sero-purulent fluid was inter-
posed. The bones themselves, instead of presenting- the usual bluish colour,
were more or less white; and the upper part of the orbitar plate of the left
maxillar}^ bone, as well as the inside of both nasal bones, was of a dead white.
The membrane lining the antra of both maxillary bones was in like manner
very much thickened, and covered with a viscid purulent secretion,- and when
this was removed, it was found to be granular, villous, and much injected.
This membrane also adhered very loosely; and when an incision was made into
it, it was found to be detached from the body plate of the antrum.
These appearances showed clearly that the inflammation of the periosteum
had destroyed the connexion between the vessels of that membrane and the
surface of the bones, and had thereby first interrupted the nutrition of these
bones, and then produced their death, or necrosis. There is no doubt, that,
eventually having now become foreign bodies, they must have been discharged
in this manner from their situation; and there is also equally little doubt that,
until this result was consummated, they must have maintained an inflammatory
action and suppuration, or a series of actions, interrupted only or alleviated in
their severity by the occasional escape of portions of bone of various sizes.
Permission to inspect the head was, from particular circumstances, not ob-
tained. I had an opportunity, however, of inspecting the outer surface of each
parietal bone near the tuberosities, to which chiefly the gnawing pains of the
head were referred; and there, also, I found the connexion between the peri-
cranium and parietal bones completely destroyed on the right side, and very
much loosened on the left. The pericranium itself was thickened, and contain-
ed some serous infiltration. But the parietal bones presented no new deposi-
tion or irregularity of their surface. It was, however, though not so white as
the bones of the nose and face, less blue than natural, and not completely dead.
The anterior surfaces of both tihix were extremely rough and irregular, with
deep longitudinal lines, presenting the worm-eaten appearance described by
the older authors. These longitudinal depressions appeared to be formed in
the substance of a new osseous deposit. The periosteum, of these bones was
thickened and indurated; but at the period at which I inspected it, it was im-
possible to say whether it had been preternaturally vascular or not.
This case I regard as particularly valuable for several reasons. It shows,
in the^rs^ place, the true cause of ozoena, and the manner in which syphilitic
or mercurial caries of the bones of the nose commences. That disease does not
originate in the bones, but always begins in the fibro-mucous tissue which
covers these bones, and by the vessels of which they are in a great measure
nourished. I do not pretend to say whether this morbid action originates from
the poison o^ syphilis, or the noxious operation of mercurial medicines; but one
thing I know to be certain, from a considerable number of cases that have fallen
under my observation, that the frequency of this disease of the periosteum is in
the direct ratio of the quantity of mercury that has been taken, and the number
of times that mercurial courses have been exhibited. The subject of the pre-
sent case had been repeatedly under the influence of mercurial medicines; and
though, like others, she had always derived from them immediate improvement,
232 QUARTERLY PERISCOPE.
this was destined to be followed by an invariable aggravation of the periosteal
disease.
Omitting, however, these considerations witli regard to the cause, this case
demonstrates unequivocally the nature of the action. It shows that the first
step of the process is inflammation of the fibro-mucous membrane covering the
facial bones; and that this inflammation commences most readily in those in
which these two membranes are in immediate contact, — for instance, the inner
surface of the nasal bones; the superior and inferior spongy bones; and the
nasopalatine plate of tlie superior maxillary bone. The next step is the effect
of this inflammation. The overloaded vessels are unable to transmit blood as
formerly, into the substance of the bone; they become detached, while they
give rise to a new morbid secretion; the bone, in the meantime deprived of its
ordinary nutriment, either becomes carious, or is killed outright, and is neces-
sarily, after exciting much irritation, expelled as a foreign body.
This representation I have derived, not from the case of this woman alone,
but from several similar ones in which I have had occasion to observe the same
train of phenomena.
In the second place, it is worthy of observation, that periosteal inflammation
produces two difl^erent effects, — one a detachment o^ periosteum^ with death of
the bone; the other a deposition of new bone, rendering the surface rough and
irregular. The former action appears to be much more violent than the latter;
and while the case of this patient presented both varieties of the action, the
former in the parietal and facial bones, and the latter in both tihix, it was the
former chiefly that produced with the erysipelas the fatal termination of the
disease. — Ed. Med. and Surg. Journ. January^ 1834.
14. MeningealJipopkxy. — M. Alegre has communicated to the Anatomical
Society of Paris an example of this in a female, seventy-one years of age, who
died suddenly. A clot of the size of an almond was found beneath the cere-
bral protuberance, between the nervous substance and the pia mater, and com-
municating by traces of coagulated blood to numerous small surrounding
coagulae, also situated beneath the pia mater. The most minute researches in
the cerebral substance could not detect any lesions from which this blood could
have come. This form of apoplexy so frequent according to M. Cruveilhier in
new-born children, is rare in adults. — Rev. Mid. February and July^ 1833.
15. apoplexy of the Spinal Marrow. — M. Monoi) has communicated an in-
stance of this rare aflfection, to the Anatomical Society of Paris. In this case
there was found near the origin of the inferior dorsal nerves, a sanguineous ef-
fusion in the central gray substance, to the extent of two inches and a half.
This effusion had commenced on the right side, and extended to the left. The
blood had diffused itself from its source along the central gray substance of the
right side, as far as the second dorsal pair of nerves. The symptoms were re-
markable: the first consisted in ]iain at the seat of the effusion; which pain ex-
tended corresponding to the effusion along the spinal column; it also extended
to the loins, along the nerves which arise from the seat of the apoplexy. The
second symptom was paralysis of motion in the corresponding limb; but a sin-
gular phenomenon, and which the cadaveric lesion did not explain, is the loss
of sensibility of the left side. The symptoms came on gradually, and not sud-
denly as in cerebral apoplexies. — Rev. Med. February, 1833.
16. Case of Meloena with the Dissection. By David Craigie, M. D. &c. —
This case occurred in the person of George Craig, a man, thirty-five years of
age, sanguine and plethoric in appearance. This man, vvho had been at one
time a soldier, but now pursued the occupation of a tailor, had been for many
years past addicted to incurable and uninterrupted habits of dram-drinking;
and all the money which he was enabled to procure was spent in indulging this
craving for liquor. For two weeks previous to his application at the hospital.
Pathology. 233
he had complained of a painful sense of weight and distention all over the ab-
domen, but referred more particularly to the umbilical region, and the upper
margin of the hypogastric. This was accompanied with sensations of dullness,
head-ache, impaired appetite, occasional squeamishness, much thirst, and ge-
neral feebleness. The head-ache subsided on the 2d or od. day; and the only
symptom which continued obstinately was the faint squeamishness and the pain-
ful sense of tension and weight, which was at admission referred to the epigas-
tric, umbilical, and upper part of the hypogastric regions, with the occasional
sickness, but without vomiting, tenderness, or tension. The tongue was white
and moist; the bowels were reported regular; the pulse was natural, from 70
to 80; and the skin of moderate warmth.
Two colocynth pills and three ounces of infusion of senna had the effect of
moving the bowels freely but gently, cleansing the tongue, and abating the ab-
dominal pain very much; and on the 14th he had no complaint except squeam-
ishness. As the pulse and cutaneous heat were natural, all medicine was
omitted; and he was left to the effect of the fever diet and time.
^ He continued easy and without complaint, except a little sickness, till about
eight in the evening", when he began to feel a sense of weight in the bell}^,
which continued till half past ten. At this time an urgent call to stool was fol-
lowed by a copious gush of pure blood from the redum, which was repeated at
different times in the course of one hour and a half, till it amounted to five or
six pounds. At 12, an opiate enema was administered; and after this no more
blood was discharged; but he continued in a very faint and languid state for
about three hours, and expired at three on the morning of the 15th.
The blood discharged from the intestines when examined next day consisted
of dark-coloured fluid blood mixed with large clotted masses.
On laying open he cavity of the abdomen, the peritoneal surface of the in-
testines was deeply stained of a dark pink-red colour, in some points lighter,
in others more intense, but particularly so long the whole course of the ileum.
In the cavity of the stomach there were found two pounds of blood, chiefly
dark-coloured, partly clotted and grumous, partly semifluid. When this was
removed the mucous membrane was observed to be deeply tinged, with red
blood, and the membrane was itself thickened and injected, but not softenedo
The mucous membrane of the oBsophagus was perfectly pale and blanched. On
holding up the mucous membrane to the light, the large vessels were seen
much loaded, and the substance of the membrane itself deeply tinged, and the
small vessels distributed through it. Upon the most careful examination of the
membrane, no blood was found issuing from any particular aperture.
The mucous coat of the duodenum was in like manner coloured deep red,
and the glands were somewhat more distinct than natural. The whole mucous
membrane of the jejunum and ileum was in like manner deeply tinged with
red blood. Fully three pouwds of blood, partly fluid, were found chiefly to-
wards the lower part of the ileum,- and when this was removed, and the mucous
membrane carefully washed, it still presented a very deep coloration, its vessels
much injected, and the villi much erected and covered with a thin pasty layer,
which was also tinged red. On the most careful examination of the whole
membrane, no aperture could be discovered, but merely a general oozing from
the membrane. Previous to removing this substance, the superior mesenteric
artery was exposed, and a quantity of water forcibly injected, but without de-
tecting any open or ruptured aperture, the water escaping only from the sur-
face of the membrane by numerous minute vessels. The intestinal glands,,
both solitary and agminated, were perfectly healthy. A small quantity of clotted
blood v/as found in diflTerent parts of the colon, but its mucous membrane was
healthy.
The liver was perfectly healthy.
The spleen was very much softened, and of a deep colour, like masses of
coagulated blood.
Head, — The membranes and surfacG of the brain, were more injected than
20*
234 QUARTERLY PERISCOPE.
natural, and its substance presented numerous dark red streaks. The ventricles
were also dilated, and contained a small quantity of" serum. A good deal of
serous fluid was found in the subarachnoid tissue at the base of the brain.
The lungs were perfectly sound.
The licart was free from disease, and its valves perfectly healthy. But the
beginning of the aorta, between the semilunar valves and the arch, was much
elevated and irregular, from steatomatous matter deposited in tubercular
masses, and especially around the origin of the large vessels; and a large crim-
son-red patch was found on the arch under the tunica intima.
The riicht kidney was deeply injected, but healthy; the left presenting some
disease of the granular matter.
These appearances show clearly that the intestinal haemorrhage which had
])roved the cause of the death of this man did not proceed from any single ves-
sel, or two or tliree vessels, which had been eroded, perforated, or ruptured,
as might have been imagined, but that it issued from the vessels of the entire
mucous surface of the duodenum, ileum, and perhaps also from those of the
stomach, previously thrown into an injected and congested condition, and then
undergoing disorganization at their extremities, as in melodna, yellow fever, and
similar states of the gastro-enteritic membrane. 1 afterwards learned from a
respectable man, who was in the habit of employing Craig, that he was a habi-
tual dram-drinker, — that all the money which he earned was spent in the pur-
chase of spirits, — and that, after he had received a i'cw shillings for his work,
he was in the habit of spending it all bv sixpences in drinking, so that he was
often days without food, or taking any thing but the deleterious liquor to which
he was so much attached; and lliai, previous to tlie iihiess which proved fatal,
lie had spent several days in this pernicious course. — Edln. Med. and Surg.
Journ. Jan. 1834.
17. On the Pendulous Tumour of the External Ear. By Dr. A. Campbell. —
At the meeting on the 2d March, 1833, a letter from Dr. Campbell was read,
containing an account of the pendulous tumour of the external ear, which is a
very frequent disease among the natives of the valley of Nipal; and often ob-
served to occur in the same individuals Vk'lio are affected with goitre. Two
tumours were sent by Dr. Campbell to the Society's Museum; they had grown
from the helices of the ears of a woman, and drew down and doubled the ear
over the external meatus auditorius, so as greatly to obstruct hearing. The
surfaces of the tumours were uneven, and their feel fleshy, but firm; their in-
ternal structure is described as resembling that of mammary sarcoma. They
v/ere removed by simple incision with a scalpel, and weighed together twenty-
four ounces. The wounds soon healed, and the ears i-esumed their natural po-
sition. The patient from v/hom these tumours were taken, is affected with a
Urge bronchocele; her eldest daughter, aged nine years, has a tumour the size
of a walnut, attached to each external ear, and another daughter, aged six
years, has a goitre of tiiree years growth, which is as large as an orange. In
the same communication the author states, that bronchocele very often occurs
in animals in Nipal, lambs and kids being often born with remarkable morbid
development of the thyroid gland; some preparations of these diseases were
also sent, as v/ell as a steatomatous tumour, the size of a small orange, which
was removed from the sheath of the penis of a dog; tliis animal was taken to
Nipal from the plains of Bengal in March, 1832, and in July the disease was ob-
served and removed. — 2'mn5. of Med. and Fhys. Soc. of Calcutta^ Vol. FZ, 1833.
18. Swelled Leg resembling Phlegmasia JDolcns, and Obliteration of the Iliac
Vein. By J. C. Boswell, Esq.— On the 8th February, 1832, an emaciated
Chinese pauper was brought before the Police at Penang, and from the circum-
stance of his not speaking, he was supposed to be insane; however, on exami-
nation, it appeared that the man was unable to speak in consequence of the
extremely low and miserable state to which he was reduced. Besides the great
Pathology. 235
general debility, there was an uniform swelling of the left lower extremity, ex-
tending from the toes to the groin. The limb was nearly three times the size
of the other; it was cool, oedematous, and it pitted on pressure, but was rather
elastic, and of much lighter colour than the opposite limb; the glands in the
groin were not swollen. As only one limb was affected, the disease was not
considered common oedema. The patient died on the third day after he was
first brought under observation. On post mortem inspection, the cellular struc-
ture of the limb was found loaded with serum. The femoral vein was turgid
with coagulated blood; the middle portion of the iliac vein appeared constricted,
as if compressed by a ligature, and there were several enlarged and indurated
absorbent glands near that part, from whence upwards the cavity of the vein
was filled with laminae of firm coagula, the extremity of which extended across
the lower part of the vena cava, above an inch into the right iliac vein, but
there was no sign of disease in the vessels of the right side. The mesenteric as
well as the bronchial glands were much enlarged and indurated; and there were
extensive marks of chronic disease in the lungs. — Ibid.
19. Case of Engorgement of the Occipital and Vertebral Ligaments— Palsy and
Mrophy of the left half of the Tongue. — A man, aged 30, whose employment it
is important to notice, as it materially influenced the development of his dis-
order, was received in this hospital in the course of last year. He was a lace-
weaver, and was accordingly obliged to work in cellars and on cold and damp
ground floors. Persons of this trade are very subject to rheumatic afl^ections,
and swellings of the ligaments of the joints. Three years ago, this man was
seized with a very sharp pain of the left and back part of the head, which to«
tally impeded him from moving the parts, and deprived him of sleep. In the
course of five or six days they changed their position, and settled in the left side
of the upper part of the neck. The pains were not now so violent, but motion
of the head was still impossible. Lateral flexion of the head, it is true, was
partly performed by the totality of the cervical column; and the head could,
moreover, be slightly bent forward and backward by the same means. The seat
of the malady was evidently in the vertebrae themselves, if it was not in the mus-
cles— a supposition which, as w& shall see, was inadmissible.
The next peculiarity observable in this case was, a difiiculty of speaking; at
first inconsiderable, but increasing gradually to such an extent, that, at the end
of two months, the patient could not be understood. He said that the air passed
by the left side of his tongue with a whistling sound, and when he wanted to say
je, he could only utter ze. There were some pains at the angle of the jaw and
in the cheek of the left side; but there was no paralysis of the muscle in that
quarter.
Another symptom now became remarkable. The tongue began to diminish
in bulk on the left side, and the diminution soon amounted to a perfect atrophy.
The organ at this part appeared to be formed of nothing more than membranous
folds, which could be rubbed together without feehng in any degree muscular;
it felt like an empty leather purse. When the tongue was put out, its right
side seemed sound enough; and the atrophy of the left, which was most visible
at the end and middle portion, was inconsiderable at the base. The right side
even seemed to enjoy a more than usual degree of strength and activity, as is
observable in other parts of the body when the corresponding parts are para-
lyzed. There was a curvature to the right side when the tongue was thrust
out. It was only in the first months that articulation was difficult or impossible -.
when examined at the hospital, he could speak as well as if there had been no
atrophy. This must have been the result of practice; for it is known that speech
can be effected by this means with half a tongue, nay with a less portion, a
third, a fourth part, and even with a stump that is scarcely visible.
1 was anxious to find what changes had occurred in the sense of taste; and
with this view I made four watery solutions of sugar, sulphate of quinine, com-
236 QUARTERLY PERISCOPE.
mon salt, and an acid. I tried them first on the healthy subject: some of the
pupils submitted to the experiment. Keeping- the tong"ue motionless, a few
drops of these solutions were apphed to the tip — there was no taste perceived;
they were applied then successively to the middle and to the base, when the
different flavours were perfectly disting-uished. Trying- the same experiments
on the patient, it was found that there was no sense of taste at the tip of the
atrophied side; but in the middle portion, and according as the base was ap-
proached, the more acute and perfect was the sense. Thus it appeared, that
though the muscles were gone, the sense of taste remained in all its perfec-
tion— a remark of very great importance.
By considering next, what nerves are distributed to these muscles, we were
still further able to form an opinion of the seat of the disorder, and the cause of
the atrophy. The nerves of the tongue are the lingual, the glosso-pharyngeal,
and the hypoglossal; the lingual being distributed to the nervous papillae of the
surface; the glosso-pharyngeal to the back part and lateral portions of the
pharynx: the first is subservient to the taste, the second to the motions of the
organ. Now the sense of taste being unimpaired, the lingual nerve was safe;
and if there had been an alteration in the glosso-pharyngeal nerve, the functions
of the pharynx would have been impaired, and the base of the tongue would
have suffered more or less from the atrophy. The nerve of the ninth pair, the
great hypoglossal, then remains; and it is worth while considering the origin
and distribution of this important agent. It arises from filaments in the furrow
situated between the corpora oUvaria and pyramidalia, on the sides of the me-
dulla oblongata, and issues from the skuli by the anterior condyloid foramen,
at the internal and posterior side of the foramen lacerum. The eighth pair, in
like manner, passes through at the same place; but it does not appear to have
been involved in this malady, for the functions of the stomach and alimentary
canal remained unimpaired. The nerve of the ninth pair receives and gives off
numerous branches: some of these are distributed to the muscles inserted in
the hyoid bone; others supply the middle cervical plexus; and accordingly, in
the present case, the left side of the neck seems to have been not so well sup-
plied as the right. This nerve, in fine, which is the true mover of the tongue,
is terminated every where in muscular parts. So much then bein^ premised
relative to the different functions of the nerves of the tongue, we shall now
consider briefly whether the atrophy depended on the brain or the nerve.
The acute pains felt by the patient at the commencement of his disorder were
simply external or superficial: there was no disturbance of the intellectual func-
tions all along; nor of the locomotive functions: there has been no palsy in parts
supplied by cerebral nerves. Nor does the medulla oblongata appear to be the
origin of the affection, for there have been no troublesome symptoms in parts
supplied from that quarter. Nor, finally, for the same reason, can the spinal
marrow be supposed the source of the malady.
Taken in every point of view, the disorder in this case appears to me to re-
sult from a lesion of the nerve of the ninth pair, not within the skull, but after
its departure from that cavity. This opinion seems borne out by the lesion of
the occipito-vertebral articulation. The inability to execute movements of the
head seems to point out some affection existing between the vertebra, the
cause of which is probably rheumatism, and the seat the ligaments. The dis-
order began on the left side: it descended to the neck on the same side; the
point de depart is then between the occipital and the first vertebra, and perhaps
even extending to between the first and second.
Diseases of this kind are by no means rare. There are in the collections of
the Ecole and the Museum of Comparative Anatomy, ten or twelve cases of
stiffness, with or without luxation, of the first vertebra with the condyles of the
occipital. Thus, in the present case, there was inflammatory engorgement,
acute or chronic, of the ligaments uniting the vertebrae and the occipital: and
as the nerve of the ninth pair passes out by the foramen in front of the occipi-
Pathology. 237
tal condyle, this nerve must have been either compressed, or altered in its tis-
sue at the point of exit; it nnust then have become atrophied, and hence the
paralysis and atrophy of the left part of the tongue.
The treatment in this case was energetic; for, as the disorder appeared to
vanish from the left side, it was found to have some tendency to migrate to the
right — the patient beginning to complain of similar, though slighter symptoms
on that side. Cupping was freely practised and frequently repeated behind
the mastoid processes, and moxas were afterwards employed. The results
were satisfactory. 1 have only to add, that this case of palsy and atrophy of
half the tongue appears to me to be a very important one: I have never met
with another example of it; and I am not aware that other physicians have
given an account of any similar complaint. — Dupuytren's Clinical Lectures.
20. Remarks on Local Diseases — Pathology of the Diseases of the Digestive
System. By William Stokes, M. D. Extracted from a lecture on the Theory
and Practice of Medicine, delivered at the Medical School, Park street, Dublin.
Session 1833-4. — Gentlemen, I commence with the digestive system. 1 am
anxious to do this for several reasons, but for none more than this — that to the
improvements made in the pathology of the digestive system we owe much of
the rapid advancement of modern practical medicine. Before our time the pa-
thology of the digestive system was very little known, and if not quite a terra
iticognita in medicine, there existed respecting it a great deal of misconception.
The schools were deeply tinctured with the doctrines of the Humoralists and the
Brownists; and this had the effect of giving rise to irrational theories and false
notions of the true state of the system in disease. The humoral pathologists,
who sought for disease in an alteration of the fluids alone, neglected the study
of visceral lesions; and when they turned their attention to the digestive sys-
tem, they only considered it, its secretions, and not its actual condition or the
state of its sympathies. The liver, with them, was an organ of the highest im-
portance, and the secretion of bile claimed a vast share of their attention. To
it they gave a paramount influence, and to an alteration in its quantity and
quality they attributed most of the changes which occur, not only in the diges-
tive tube, but also in the whole system; and hence the great object of their
practice was to attempt to restore its healthy condition, convinced that if this
were once accomplished, every thing would go on favourably. From this too,
arose the purgative plan of treatment in various forms of intestinal disease, a
plan too often rashly pursued, even where there was unequivocal proof of in-
flammation in the digestive tube. Their sole purpose was to evacuate sordes,
to produce a flow of healthy bile, and to eliminate depraved secretions; and
they did this without possessing any knowledge of local inflammation, or of the
effects of disease of the digestive system on other organs. The followers of
Brown, on the other hand, only admitted disease of the digestive system in a
state of intense, manifest violence, as for instance, ileus, or violent enteritis;
but in the great majority of cases, they did not recognise intestinal inflamma-
tions, because their prominent symptom was prostration, or to use their own
terms, an asthenic condition of the whole system. They saw nothing but pros-
tration; they prescribed for nothing but debility; they gave wine instead of iced
water; ordered bark instead of local depletion. They exasperated the disease
by stimulants; and then, thinking they had not gone far enough, they heighten-
ed the stimulant and doubled the debility.
Another cause of the low state of pathology in form.er times was the general
neglect of dissection. The fact is, that in fever there were no post mortem ex-
aminations made, until very lately. Morgagni, who did so much for pathological
anatomy on almost every other subject, did little for fever, because he was
afraid to dissect the bodies of persons who had died of a contagious disease.
This was the idea which prevailed among the older pathologists; and hence this
source of knowledge was avoided, and for many successive centuries the state
238 QUARTERLY PERISCOPE.
of the viscera in fever was a matter of speculation, doubt, and uncertainty. Even
at the present day it is only done by the ardent patholog-ist, who cares not about
filth and stench, and who had rather encounter the miasm of contag"ion than re-
main in the mists of error. Nothing- is more common, I regret to say, even at
the present time, than this: — A person says he has dissected cases of fever, and
when asked whether he had examined the intestinal canal, he says that the in-
testines appeared healthy, but he did not make any particular inspection of
them; he only opened the belly, and, finding- no trace of inflammation in the
peritoneum, he went no further. Now nothing can be more useless than such
an examination. If we compare the information afforded by an inspection of the
serous membranes of the three great cavities, we shall find that the least is
given by an examination of that of the abdomen. Disease of the substance of
the brain is rare without affections of its investing membrane, disease of the
substance of the lung is exceedingly rare without the occurrence of disease of
the pleura, but you may have most extensive and fatal disease of the intestinal
canal without the slightest lesion of the peritoneum. In this point, therefore,
it differs from the pleura, and from the arachnoid membrane. The fact of the
rarity of disease of the peritoneum in cases of disease affecting the parts beneath,
was noticed by Dr. Graves and myself, in our report of the Meath Hospital, and
also by Mr. Annesley, in his account of the diseases of India. You will see
cases of hepatic abscess, which present a distinct tumour externall}^ and where
you can detect a perceptible fluctuation; and yet, if you examine these cases
after death, you may not find any adhesions of the peritoneum, even in the si-
tuation of the abscess. You will find the mucous and muscular coats of the
colon extensively destroyed, you will see the stomach all but perforated, you
will meet with cases where the whole ileum is one extensive sheet of ulcera-
tions, with no disease in the adjacent peritoneum.
In entering on the consideration of diseases of the digestive system, we shall
begin first with the mucous expansion of the stomach and intestines, and then
proceed to the affections of the solid viscera connected with them. The mu-
cous surface of the stomach and intestines is of enormous extent and extraordi-
nary sensibility, possessed of innumerable and powerful sympathies; its influence
is felt by almost every organ in the body, formed for receiving and elaborating
every thing destined for nutrition; its conditions, both in health and disease,
are entitled to the deepest and most attentive consideration. To facihtate
the study of its affections, and for the sake of some practical arrangement,
we shall divide its diseases into five classes, beginning with the oesophagus, or
that portion of the digestive tube which is above the diaphragm, and then pro-
ceeding to the stomach, duodenum, ileum, colon, and rectum. But in order to
give you a clear idea of diseases of the intestinal canal, I shall commence with
diseases of the stomach; because, if you consider the whole range of animal
life, you will find that its functions are the most important, the stomach consti-
tuting, as it were, the source and fountain of life, which is nutrition, and giving
by its existence a character to all the upper classes of animals. No organ pos-
sesses such remarkable sympathies as the stomach, whether we look upon them
as sympathies of organic or of animal life, none possesses such remarkable power
and influence in modifying the conditions of every part of the system. But,
putting aside physiological reasons, let us come to practical matters. The suc-
cess of almost every form of medical treatment, all the advantages to be derived
from the administration of internal medicine depend upon the stomach; in fact,^
in whatever point of view we consider it, we must look upon a knowledge of
the state of the stomach as the great key to sound and successful practice.
It is a most useful reflection to consider the extraordinary frequency of dis-
ease in some portion of the digestive tube. It is now admitted by every person
possessed of experience in the causes of mortality, that more human beings die
with acute or chronic diseases of the digestive tube than with diseases of any
other part of the system. This has been established by numerous investiga-
tions, and is admitted by the best pathologists; and, indeed, I think it can be
Pathology. \ ^39
easily accounted for, when we call to mind how many persons die of some form
of fever or other, when we look to the ravages of remittent and yellow fever,
to the hundreds of thousands who annually perish by the various classes of
fevers. Now in almost every one of these cases, disease of the dii^estive system
forms one of the most prominent pathological characters. Recollect, besides,
all that die of dysentery, whether sporadic or simple, and here is inflammation
of the colon? see too, how may die with diarrhoea, — here too, there is intestinal
disease; remember how many die of the malignant intermittent of the West In-
dies, in which unequivocal proofs of disease of the stomach and intestines have
been found. Observe what a close connexion there is between tabes mesente-
rica, and inflammation of the mucous membrane and surface of the intestines;
think what a vast number of persons fall victims to the harassing effects of con-
stipation and dyspepsia; and recollect that there is a host of diseases in which
the train of morbid phenomena commences in the digestive system, and then
exhibits itself by functional alteration or organic disease of other parts.
Gentlemen, we recognise the presence of disease in the digestive tube, first
by the local phenomena and the lesion of the digestive function, and next by the
sympathetic relations of other parts, by the sympathies of the respiratory sys-
tem, of the circulation of the skin and of the nervous system. I shall enume-
rate the local phenomena and functional lesions: vomiting, anorexia, thirst,
jaundice, pain, tenderness on pressure, tympanitis, changes in the character
and quality of the discharges, constipation. Here are a set of functional lesions
and local phenomena, let us now consider the sympathetic relations; these are
fever, heat of skin, suppression of the cutaneous secretion, suppression of the
secretion of urine, morbid states of the tongue and pulse, pains in the chest and
cough, hurried breathing, and palpitations of the heart. In the next place, we
may have prostration of strength, dehrium, coma, convulsions, tetanic spasms,
and other symptoms of functional disease of the brain; these are all sympathies
of relation. Now, in the first place, I have to remark, that there is a great deal
of variety in the combination of these symptoms. On what does this depend?
on a variety of circumstances; sometimes on the intensity or extent of the in-
flammation; sometimes on the situation of the disease; sometimes on the com-
plication of the affection; sometimes on the various modes and degrees of sus-
ceptibility of the individual. All these causes tend to produce a great variety
in the disease, and an extensive modification of the sympathetic relations. For
instance, in some cases, inflammation of the stomach and intestines is so slight
that the patient is not prevented from going about and pursuing his ordinary
avocations; in others, on the contrary, the patients are struck down at once by
the violence of the disease, and are carried off by the fever which accompanies
it before the inflammation is completely developed. It varies also according
to situation; there is a difference between gastritis and dysentery, in the former
we have an inactive state of the great intestine, and consequent constipation in
the latter, the colon is thrown into violent action, and there are frequent dejec-
tions. Disease of the duodenum is attended Math a very remarkable peculiarity,
being very frequently complicated with jaundice; here is a modification pro-
duced by situation. Again, inflammation of the ileum is attended with a very
curious peculiarity, namely, the absence of pain. The patient states, that he
feels unwell, he has obscure symptoms of intestinal disease, but it is neither
dysentery nor gastritis; you investigate it with care and find that the ileum is
in a state of inflammation. Yet the patient does not complain of any pain, and
this is another peculiarity depending on situation.
But in considering the differences which depend upon intensity, extent, and
situation of disease of the intestinal canal, we must not omit those which de-
pend upon tissue. If disease be confined to the mucous membrane of the in-
testines alone, we may have an extremely diffused and extensive inflammation
sufficient to destroy life, without any pain being complained of by the patient,
it is a painless though fatal disease. Recollect this, 'extensive and fatal inflam-
mation without pain. In former times the ideas of pain and inflammation were
240 QUARTERLY PERISCOPE.
inseparable. Thanks to the light which patholog-y has shed upon modern me-
dical science we are now acquainted with this seeming anomaly, and can con-
ceive the existence of extensive disease of mucous surfaces unaccompanied by
pain. But let the inflammation seize on the muscular tissue, the character of
the disease is instantly changed, and the pain is dreadful. Here is a case in
which difference of tissue is to be taken into consideration.
The phenomena and sympathetic relations of intestinal disease may vary also
according to its complication, and here we come to investigate one of the most
beautiful laws of the human economy, namely, that the more complicated a dis-
ease is the more latent will be any local lesion. This is a point that should
never be forgotten. For instance, enteritis by itself is much more easily recog-
nised than when complicated with pneumonia, or with irritation of the brain,
and gastritis is but too often completely masked by being combined with irrita-
tion of the bronchial raucous membrane. Lastly, we have the varieties which
depend on different degrees of susceptibility. In one person we may have
only slight cerebral irritation, in another high excitement, in a third delirium
and extraordinary convulsions. The variety, then, in the modifications of dis-
ease, and the combination of sympathies is very great, and is referable to the
extent and the intensity of the inflammation, difference of situation, complica-
tion of disease, difference of tissue, and different degrees of susceptibility. I
shall give examples of these at my next lecture, and then proceed to the patho-
logy and treatment of gastritis. — Lond. Med. and Surg. Journ. January Ath, 1834.
MATERIA MEDICA.
21. Formulsefur Preparations of Eydriodate of Iron. — M. PiERatJijf who has
successfully employed the hydriodate of iron in amenorrhoca and leucorrhcea,
has published in a recent No. of the Bull. Gen. et Therap. the following for-
mulae:—
1st. For pastilles. R. Hydrod. ferri, ^j.; pulv. croc, sativ. ^iv.; sacch. alb.
§viij. M. fit. 240 pastilles. 8 or 10 grains to be given daily, and the dose gra-
dually increased.
2d. Tincture. R. Hydrod. ferri, ^ij.; alcohol, aq. purse, aa. ^ij. M. A
tea-spoonful night and morning for an adult.
3d. Enemata, injections and lotions. R. Hydrod. ferri, ^iv. ; aq. puree.
ibij. M.
22. Ointment for the Cure of Porrigo.—M. Biett considers the following as
one of the most powerful agents for the cure of porrigo: — R. loduret. sulph.
^j, to ^ss. ; axung. ^^j. M. A drachm is usually employed at each friction. —
Bulletin G^n. de Therapeutique, Tom. IV. ^ 1833.
23. M. Aubergter's Potnatwn for Preventing the Hairs from Falling Out.—
R. Prepared marrow of beef, ^vj.; sweet almond oil, ^ij-i red Peruvian bark,
^j. The powdered bark is to be moistened with a small portion of the almond
oil, and the remainder then added; when the mixture is made, the marrow is to
be melted at a moderate heat, and gradually added to the preceding ingre-
dients in a mortar, and rubbed together until cold. It is asserted to have never
failed in preserving the hair. — Ibid.
24. Improved Method of Administering Epsom Salt. — Dr. James Heivrt, of
Dublin, recommends the sulphate of magnesia given according to the following
formula as an agreeable, safe and efficacious purgative. Saturate any quan-
tity of cold water with sulphate of magnesia; filter through paper, and add to
every seven ounces of the solution one ounce of the dilute s\i\phnvic acid of the
Dublin or Edinburgh pharmacopoeias.
Materia Medica. 241
Dose. — One table-spoonful in a uine-f^lass of water.*
In those cases in which the bowels are very easily moved, a single table-
spoonful is sufficient to produce a considerable purgative effect.
In ordinary cases, a table-spoonful taken an hour or two before breakfast pro-
duces one or two evacuations immediately after breakfast.
In other cases, the dose is to be repeated once or twice, at intervals of two
or three hours, according to circumstances.
Where the symptoms are urgent, a table-spoonful may be given every hour
until the effect is produced; and where the urgency is extreme, a saturated so-
lution of the salt, containing only one-half of the above-mentioned quantity of
acid, may be given in doses of two table-spoonfuls, repeated every hour.
This combination of sulphate of magnesia and sulphuric acid, administered
according to the preceding directions, possesses the following properties.
1. It is an effectual purgative, never failing to move the bowels in all cases
in which the bowels can be moved by medicine. I am not acquainted with any
purgative which is more certainly effectual.
2. It is quick in its operation; the effect being produced in ordinary cases
within two or three hours after the first or second dose, and a necessity rarely
arising for the continuance of the medicine beyond the third dose.
3. It is safe, never purging so as to produce exhaustion.
4. It does not give rise to the slightest degree of nausea, but, on the con-
trary,
5. Quickly puts a stop to nausea, and appeases irritability of the stomach.
6. Flatulence, that most distressing attendant upon constipated bowels, is
immediately and signally relieved by this medicine, which not onl}'^ promotes
the expulsion of the flatus already generated, but diminishes the tendency to
its further secretion.
7. In a few minutes after this medicine has been swallowed, so agreeable a
sensation of warmth is felt in the stomach, that the medicine is not only readily
taken, but even relished by many persons whose stomach will not retain any
other liquid purgative, unless impregnated with the hottest aromatic tinctures.
8. The operation of this medicine is not attended by either sickness, faintish-
ness, or griping. In this respect the acid sahne solution possesses a remarkable
superiority over all the purgatives in common use.
9. This medicine can be taken every day, or every second day, for a consi-
derable length of time, not only without impairing the stomach or other diges-
tive organs, but with manifest advantage to them.f
10. The continued use of this medicine does not produce that irritation of
the rectum which so commonly attends the continued use of other purgatives.
11. This medicine is not disagreeable to the sight, being perfectly limpid and
transparent as the purest spring water.
- 12. It has no smell,
13. The bitter nauseous flavour of the sulphate of magnesia being almost
completely hidden by the acid, the taste of the solution can hardly be said to
be at all disagreeable, and is certainly much less so than that of most other
liquid purgatives.
14. It is cheap.
15. It is easily procured everywhere.
16. It keeps for an unlimited length of time.
From the experience of three years, during which I have made daily use of
this purgative in the course of my practice as a physician, I have ascertained
that the acid saline solution possesses the properties which I have just enumer-
ated.— Edin. Med. and Surg. Jaurn. January^ 1834.
* Each table-spoonfiil contains about two cli-achms of sulphate of magnesia, and half a drachm of
dilute sulphuric acid.
t The frequently repeated contact of the acid saline solution bein^ injurious to the teeth, it is useful
to adopt the precaution of taking the medicine through a quill, or from: the spout of a small tearpotj,
whenever it is necessary to continue its use for any length of time*
No. XXVII.—Maj, 1834. 21
242 QUARTERLY PERISCOPE.
25. On a preparation uf Opium. By J. C. Boswelx, Esq. Assistant Surgeon,
Penang". — I have been using for a considerable time past, in the Hospitals under
nay charge, a preparation of opium as a substitute for the liq. opii sedit. and
tinct. opii, which I now beg leave to bring to notice, as I feel desirous to ob-
tain the opinion of others relative to its virtues. The preparation I am nov/
using, was made soon after I was put in charge of the Medical Stores.
Having occasion to make a quantity of the tincture, I felt at a loss what to
do with the residue after the tincture had been strained, when on reference to
Paris' Pharmacologia, (see Note, Art. Opium,) it is stated, that Mr. Haden had
macerated the dregs in a solution of tart. acid, and had found the product as
strong, and superior to the tincture, inasmuch as it wa3 devoid of either stimu-
lating or binding qualities. After the trials I have made, I think I can almost
confirm that statement.
My solution was made by adding about two-thirds the quantity of water,
which I had previously obtained of tincture, with what I deemed sufficient of
tart. acid, the solution was frequently shaken, and left for a month, then filtered.
The dose I usually give is, from gtts. 50, to ^j. — Trans, of Med. and Phys. So-
ciety of Calcutta, Vol. VI.
26. Opium used at the General Hospital, Calcutta. By W. Twinijtg, Esq. —
I have used the opiate solution sent from Penang by Mr. Boswell; the quantity
would not allow of any to be spared for chemical analysis, so as to ascertain the
relative proportion, and exact nature of the solid matter in this medicine. It
would be desirable to ascertain from Mr. B. whether the dregs left after the
preparation of laudanum, were used in making this medicine in a wet or dry
state;— also, what were the exact proportions of tartaric acid and water em-
ployed.
The whole of the solution was administered to sick and convalescents in the
General Hospital, and it appears to possess considerable efficacy: its anodyne
and soporific properties do not seem equivalent to half the strength of vin. opii;
but its action is peculiar, and if the present trials will enable me to judge cor-
rectly, I should state that it is a less exciting opiate than laudanum, when admi-
nistered to patients in an irritable condition, and suffering from a slight degree
of pyrexia; it is less liable to affect the head, or to produce constipation of the
bowels, and is seldom or never followed by disorder of the stomach or impaired
digestion, and it has a greater tendency to produce perspiration, than either
laudanum, or vin. opii. Patients who had been in the habit of taking large
quantities of laudanum, were unwilling to acknowledge that the opiate solution,
now alluded to, had any evident effect either in the dose of one or two drachms.
Since the above report was drawn up, I have obtained twenty-one pints of ano-
dyne solution prepared by dissolving gxxi. of tartaric acid in twenty-one pints of
distilled water, which was carefully mixed with the dregs left after making sixty-
three pints of laudanum, according to the formulcc of the London Pharmacoposia.
Jeremie's opium was used in making the laudanum, and after it was filtered,
the whole of the dregs were left on the filter for fourteen days; being then in
the state of a tough paste, and about as firm as an ordinary mass for making
pills, the above solution of tartaric acid was mixed with the mass, and the fluid
stirred daily for fourteen days, and then strained. The relative proportion of
water is only half as much as Mr. Boswell used. The medicine prepared in this
way is about as high-coloured as equal parts of claret and water: it is transpa-
rent, and a mouldy coat forms on the top of the fluid in each bottle in the course
often days.
I have used the whole 21 pints of this solution in cases of severe pains of the
bones and joints, affecting men who were emaciated and had broken constitu-
tions from long residence in India, and from the frequent use of mercury.
These patients were the military invalids who arrived this season from the Up-
per Provinces, in the course of transmission to Europe. The medicine was of
the greatest benefit to patients of this class, who earnestly requested its re-
Practice of Medicine. 243
petition after having" once experienced its effects. It was usually followed by a
warm perspiration extending- over the whole body and extremities; and the
patients procured more refreshing sleep than after any other opiate. I be-
lieve its exhibition never caused head-ache, and it seldom or never produced
constipation of tlie bowels: in upwards of 40 patients who took this medicine,
only one complained of constipation. In one case of most excruciating pains
arising from irritable ulcers of long duration, the patient procured comfortable
sleep, and was entirely relieved of his pains by doses of giv. of this solution
given every night at bed-time. This patient is a Greek, who had formerly used
large quantities of opium. Another patient with irritable ulcers and severe
pains in his limbs always slept well after taking doses of ^iii. every night. No
other patient required a larger dose than ^ii. I have administered this prepara-
tion of opium, with great benefit, in the dose of ^ss. twice a day, combined
with ten mJnims of Fowler's solution of arsenic, in some cases of irritable ulcers;
and in irritable eruptions of great obstinacy and long continuance; in which
many other remedies had previously produced no evident benefit. — Ibid.
PRACTICE OF MEDICINE.
27. Sulphate of Quinine and Tobacco taken as Snuff in the Treatment of Inter-
mittent Head-aches. — Dr. D'Huc says, that he has employed with success in in-
termittent cephalalgias, a snuff composed of fifteen grains of sulphate of qui-
nine mixed with an ounce of tobacco. The whole is to be taken during the
course of five or six days. — Eev. M^d. May^ 1833.
28. On the Employment of Chlorine in Pulmonary Affections. — The Transac-
tions Medicales for February, 1833, contain an interesting- article on this subject
by Dr. Bourgeois. This physician having seen two apparently desperate
phthisical patients relieved, without being submitted to any medical treatment,
but who resided at a bleaching establishment near St. Denis, the atmosphere of
which is impreg-nated with chlorine, was induced to form a similar atmosphere
in the chambers of some young- phthisical patients in the Royal School at St.
Denis. This medication, though it did not cure these patients, ameliorated
their condition, diminished their dyspnoea, promoted sleep, gave them appetite,
destroyed the foetor of the sputa, and changed it from sanious to mucous. These
advantages lead M. B. to hope that in the earlier stages of the disease it may
effect a cure; in those in which it was resorted to by M. B. there were large
purulent collections in the lungs.
29. Iodine in Mercurial Salivation. — In our last No. we stated that Iodine had
been successfully employed in Germany as a cure for mercurial salivation. We
are now enabled to furnish some further details as given by Dr. Kluge of Ber-
lin, in Hecker's Medical Journal.
*' Professor Knod Von Helmenstreitt, in Aschauffenburg, was the first who
recommended iodine in mercurial salivation. (See Hufeland's Journal, May,
1832.) As the syphilitic wards of the great hospital, (Charite,) in Berlin, af-
ford numerous examples of this affection, I determined to give iodine a fair
trial, and for this purpose I selected seventeen cases, viz. twelve women and
five men, all of whom laboured under severe mercurial salivation. Helmen-
streitt's first directions were to dissolve five grains of iodine in two drachms of
spirit of wine, to which two ounces of cinnamon water, and half an ounce of
syrup are to be added. Of this the patient was to take at first half a table-
epoonful four times a day, which dose was to be gradually augmented two,
four, six, or even eight grains daily. His latter directions prescribed two
grains, or even more, the first day, which dose was to be rapidly increased.
^•Two young women who lost four or five pints of saliva daily, were cured
244 QUARTERLY PERISCOPE.
ia three days by eight grains. One man and one woman got well in four days,
having taken ten grains. In two men and four women the ptyalism ceased
entirely in six days, during which each had taken from twelve to sixteen grains.
In two men and two women the spitting was cured on the seventh day after
iodine had been taken to the amount of from twenty to twenty-eiglit grains.
In the latter cases it was, however; remarked, that the great pain of mouth
and foetor of the breath were notably diminished after one day's use of the
iodine. In two young women the remedy appeared at first to be of little or no
use; in both the salivation amounted to tliree or four pints daily at the termina-
tion of the seventh day, and the only advantage gained appeared to be a cer-
tain diminution of soreness of mouth. One of tliese patients was then obliged
to desist from the use of the remedy on account of some constitutional symp-
toms, and I looked upon this case as a failure. This conclusion was however
too hastily made, for the good effects of the iodine began to appear on the fol-
lowing day, and on the third day after she had left it off, that is, on the eleventh
from the date of its first exhibition, all morbid secretion of saliva had disap-
peared, and the gums had very nearly recovered their healthy appearance; in
short, the patient had recovered, having consumed thirty-four grains of iodine.
In the other young woman we stopped the exhibition of iodine on the tenth
day, at which time she had taken tliirty-six grains, with the effect of diminish-
ing the daily secretion of saliva from five to three pints. On the twelfth day
she was well.
"In one girl the accidental occurrence of erysipelas of the face prevented
the continuance of the remedy. The use of the iodine did not produce in any
one of these patients any disagreeable or untoward symptoms, and as I kept
them all for some time in hospital after the salivation had ceased, t have the
pleasure of likewise testifying that the cure was not only safe, but permanent."
Dr. Graves of Dublin, has also tried the effects of iodine in arresting saliva-
tion, with favourable results. — Dub.Journ. of Med. and Chem. Sciences, Jan. 1834.
30, Treatment of Chronic Bronchitis. — Dr. Craigie, in an interesting report
on the cases treated in the Royal Infirmary, contained in our Edinburgh cotem-
porary for Junuary last, states that the remedies under which recovery from
bronchitis was most readily effected were, blood-letting from the arm to the
amount of sixteen or eighteen ounces, followed by the detraction of blood from
the chest between the shoulders, by cupping or leeches, or both, or from the
anterior part of the windpipe by leeches, blisters between the scapulse, and a
mixture of squills and antimony, with opiates. In some Dr. C. found a powder
consisting of one drachm of supertartrate of potass, half a drachm or a scruple
of carbonate of soda, and ten grains of nitrate of potass, of great use in cases in
which there was reason to apprehend, from the scantiness of the urine, that the
disease was passing from the bronchial membrane to the submucous tissue, and
beginning to effect the circulation of the lungs.
In several cases of the chronic disease Dr. C. tried the tincture of the Lobelia
inflata,- but in one only, in which other remedies were also used with benefit,
did it seem to be productive of advantage.
In cases of chronic bronchitis of aged enfeebled subjects, with excessively
profuse secretion of frothy mucous fiuid, Dr. C. found acetate of lead and opium
in doses of three or four grains of the former to half a grain of the latter, three
times daily, of much use. This remedy required to be alternated vi'ith the use
of the compound colocynth pill, or a small dose of castor oil every second or
third day, according to circumstances, in order to obviate the effects of consti-
pation.
Another agent equally powerful, and not so liable to injure, in the treatment
of chronic bronchitis with profuse secretion, is according to Dr. C. the sulphate
of zinc, with extract of hyoscyamus or opium; in doses of one or two grains of
the former, to two or three of extract oViyoscyamus, and half a grain of opium.
Its effect is not merely to check undue secretion by its astringent powefj but
Practice of Medicine. 245
by operating on the capillaries generally, and those of the bronchial membrane
in particular, it tends to restore their natural properties, and propel their con-
tents in the proper channels.
31. Remarks upon the Nature of Neuralgias, and their Treatment. By M.
PioKaT. — As the vast majority of neuralgic affections do not terminate fatally,
the lesions which they may produce in the nervous tissue, remain as yet almost
unknown; and it is impossible for us to decide whether an irritation, or even
indeed a hyperemia has, or has not existed. The larger proportion of cases of
pharyngitis treated at the hospitals Salpetriere and La Pitie, though exhibiting
a short time before death all the symptoms of this affection, when examined
after death, offered no traces whatever of the disease. If such is the case in
inflammations of the mucous membranes, may we not with more reason attribute
to the affections of the nervous system a similar series of phenomena. The
morbid lesion which attacks the nervous trunk, may in like manner affect se-
parately and independently the numerous filaments which enter into its com-
position, and which are so exceedingly minute, that the anatomist labours in
vain to isolate them. How is it possible then, for us to decide upon the different
shades or tints which these filaments may assume. This circumstance is de-
serving of recollection, for it is by the colour of the nervous matter of the
brain, that the pathologist pronounces upon the previous existence of inflam-
mation in this organ. The blood-vessels supplying these nervous filaments are
also so exceedingly minute, that to be able to appreciate in them a state of
hyperemia, it is necessary that they should be enormously enlarged. More-
over, the cellular tissue of a nerve, which connects its filaments to each other,
may take on inflammation, and present a red colour, without the filaments
themselves being at all concerned. The causes which operate in the produc-
tion of neuralgic affections, are the same which produce in other organs irri-
tation and hyperemia. A contusion, pressure, violent and sudden muscular
contraction, a carious tooth operating as an irritant to the nerve supplying it,
an organic lesion of the heart, an articular rheumatism, which, whatever may
be said to the contrary, is in fact an inflammation of the joints; a tumour situated
upon a nerve, an active inflammation of the surface of the body, extension of
the inflammatory action from the intestines to the nerves supplying them, cer-
tain movements of the muscles of the head, acting upon some of the neigh-
bouring nerves, extension of the irritation which accompanies cancer, and the
pressure which an enlarged gland sometimes produces upon a nerve, are some
of the appreciable causes which tend to produce these affections; and although
we are unable to seize upon these, or similar ones in all cases, yet we should
not conclude on this account, that they were not present, but rather ascribe to
the imperfection of our means of investigation, their escape from our senses!
The group of symptoms does not distinguish neuralgia from neuritis, only
the one is transitory in its effects, whilst the other remains stationary for some
time. This is to be attributed to the morbid action resting in the first case at
its first or mildest stage, whereas, in the second, it passes on to its second, or
most violent degree. Perhaps the one may be considered as bearing the same
relation to the other, that a cerebral congestion does to a softening of the
brain. This comparison, it is true, does not throw much light upon the nature
of the case, for we have yet to form positive opinions relative to cerebral con-
gestions and cerebral softenings; nevertheless, the analogy between the two
affections is so strong, that it may be well to make use of the simile. Because
the pain is not augmented by pressure, because it assumes various characters,
because it may be subject to remissions, and because there is neither redness,
beat, nor swelling, nor indeed any of the precursors of inflammatory action pre-
sent, we must not conclude, that no congestion or inflammation of the nerve
exists; for pressure does not always produce pain in cases of congestion or in-
flammation in other parts. Moreover, the hyperemias which succeed to a le-
sion of a nerve, or which may accompany it, are subject both to variations in
21*
\
246 QUARTERLY PERlSCOfE.
their nature, as well as to remissions. Ag-ain, from the nerve being invisible,
it is of course impossible to observe the different changes in colour, the degree
of heat, or of swelling which it may undergo; and finally, there are many cases
of inflammation, in which none of the precursory or pathognomonic symptoms
of this condition show themselves. M. Andral has well observed, that the
symptoms given by authors as characterizing these affections, may lead us to
mistake a neuralgia for a neuritis, and vice versa. He considers the best means
of distinguishing the two affections from each other, to be the augmentation in
volume of the nerve affected with neuritis, but unfortunately in the great majo-
rity of cases this augmentation cannot be detected. The results of different
methods of treatment do not establish more definitely the differences that exist
between the two diseases, for it has happened, that in cases which were essen-
tially neuralgias, sanguine evacuations either produced an amelioration of the
symptoms, or cured them completely, or changed them from continued to in-
termittent, and this too as speedily and as effectually as they did in cases v^^hicli
V ere considered as well marked neuritis. On the other hand, the sulphate of
quinine operated very beneficially in a case, the intermittent symptoms of which
seemed to be dependent upon neuritis, which had originally been accompanied
by a physical lesion of the nerve, (a neuroma.) It most frequently proves
useful in those cases in which the previous application of leeches had produced
decided relief. Hence, even admitting theoretically, that the neuralgic affec-
tions constitute two degrees in the lesion of a nerve, or even that they are es-
sentially different in their nature, it must be confessed, that neither the patho-
logical phenomena, nor the symptoms, nor indeed the treatment, furnish signs
sufriciently well-marked to induce us to form very different therapeutic indica-
tions for these two morbid conditions.
The same remarks apply to the efforts which have been made to establish a
diagnosis between neuromyelitis and neurilemmitis. The observation of Riel
has been copied by every one, without its truth having ever been properly as-
certained; it would have been much better to have tested its truth by repeating
his experiment, and until it is positively shown that the neurilema of a nervous
filament may take on a state of inflammation, whilst the pulp it contains re-
mams unharmed, and vice versa, we cannot give credit to the subtle divisions
made of this class of diseases, which divisions were certainly never deduced
from sound pathological investigation. The neuronrias mentioned by Galen,
Valsalva, and Petit, and upon which MM. iJupuytren, Alexander, Boisseau,
Eeclard, Descot, Andral, Schiffner, and Cruveilhier, have published such im-
portant and interesting observations, seem in some cases to be dependent upon
the previous existence of some cancerous affection, and in others to result from
the morbid action which constitutes neuralgia and neuritis, which affections in
turn miake their appearance. Their symptoms are the same, though the treat-
ment is different, for in these cases we know positively the situation of the or-
ganic lesion, and also that where other remedies have failed, an operation is
absolutely required to effect a cure. There are, however, certain distinctions
wliich may be drawn between the neuralgias and the neurites, according to the
nature of the causes producing them, or the peculiar nerve attached. M. Lem-
bert, who has published some very useful observations upon the endermic me-
thod of medication, is induced to believe from several facts which he has no-
ticed, that certain nerves, which he thinks are more vascular than others, and
■which preside over the functions of touch and nutrition, such for instance, as
the branches of the fifth pair, are more disposed than the other nerves of the
body to attacks of neuritis, and less to attacks of neuralgia, and that sanguine
emissions are more useful in the first class than in the second. Experience and
future observation upon the functions of the different nerves must decide the
merits of this opinion. In all cases where the nerve undergoes a morbid altera-
tion sufficiently violent to give rise to symptoms, a peculiar pain, which is pro-
pagated through all the nervous ramifications, and which in some cases seems
to proceed from the branches to the trunk, manifests itself. The sensation
Practice of Medicine. 247
produced, is that of stiffness or painful numbness, accompanied by a pricking
and vibratory feeling", which continues a longer or a shorter period, according
to the nature of the circumstances that determine its production. If the exciting
cause suddenly ceases to operate, and if the lesion sustained by the nerve has
been trifling in its extent, the pain gradually subsides, and in a short time
every thing reassumes its original healthy action. (The pain caused b}^ pressure
of the cubital nerve at the elbow-joint, or of the sciatic nerve where it emerges
from the pelvis, or in the popliteal space, and that produced by the pressure
of the child's head during labour, may be cited as examples of this kind.) If,
however, the exciting cause is more violent in its operation, the painful sensa-
tions continue for a longer time, or should they perchance abate or disappear
for a time, soon retiu'n. The exacerbations take place from time to time, and
in some cases obey the law of periodicit}^, for in disease, as well as in health,
the nervous functions possess a tendency towards intermission. (The pain
caused by a carious tooth, constituting odontalgia, that produced by cancerous
tumours in the arm-pit and uterus, v/hich irritate or compress the nervous
trunks of the arm and thigh, 8cc. may be placed among the examples of this
species.) In these cases the pain persists as long as the cause producing it
continues to operate, and is incurable unless the latter be removed. The pain
which is at first confined to the trunk, or filament affected, may gradually ex-
tend itself to the neighbouring nerves, (odontalgia following some of the various
neuralgias of the face,) or it may make its appearance in several points of the
nervous system at the same time. In these cases the secondary neuralgic
symptoms may generally be relieved, but it is not until the primitive affection
is recognised and eradicated, that we can trust to their non-appearance agaiuo
Consecutively to the operation of either a transitory or persistant cause, the
nerve may become the seat of a simple irritation, which cannot be conceived
to occur, except in cases of anemia or chlorosis, without a congestion of the
sanguine capillaries, since all organs in a state of excitation have their capil-
laries injected. In this case, however, we are obliged to acknowledge the
existence of such a state of things, by analogy alone, since it is impossible to
examine the peculiar condition of the nerve during life, and if examined after
death it does not present the same characters, which it would have done if ob-
served during the existence of pain. Yet in cases of iridian or ophthalmic neu-
ralgia, as soon as the symptoms declare themselves, the eyelids and the neigh-
bouring parts are found to be in a state of congestion; if the disease is confined
to this degree of excitement and primitive congestion, we have only a neuralgia
produced. When an attack of neuralgia has existed for any length of time, it
frequently happens that there exists great tendency to a relapse, notwithstand-
ing the original cause of its appearance has been completely eradicated. It
seems in these cases that the system acquires a sort of habit, which it is ex-
tremely difficult to overcome. If the cause has operated with violence, or is
continued for any length of time, or should the disease be augmented a degree
in intensity, an inflammation of the nerve may be the result. The neuritis thus
brought about may be either followed or accompanied by hypertrophy of the
nerve; by a deposition of blood or pus between its filaments; by the formation
of hard or scirrhous tumours in its substance; or of small cysts, the parietes of
which are hard, and contain a sort of gelatinous fluid; or of encephaloid dege-
nerations, &c. The pain experienced in the nervous trunk, or in its filaments,
is so peculiar in its character, that it is impossible to confound it with any other.
It resembles precisely that which is perceived when the inner side of the elbow-joint
is suddenly pressed upon or struck. In doubtful cases of chronic rheumatism or
gouty arthritis, or of musculitis, 8cc. the abscence or presence of this peculiar
sensation will decide at once the character of the affection, and it is important
to bear in mind this fact in the examination of our patient.
Treatment. — Reasoning from the facts just given, the indications to be ob-
served, and the course to be pursued in the treatment of neuralgias, seems to
be as follows. 1st. Endeavour by all possible means to find out the material
248 QUARTERLY PERISCOPE.
or organic cause which has produced, or which is at the time operating in the
production of either the neuralgia or neuritis, and destroy it if possible at once.
Examples. (Extract the carious tooth in odontalgia dependent upon its irritat-
ing properties; prevent certain muscular movements which seem to operate in
the production of the disease; remove tumours situated upon the nerve, &c.)
should the organic cause be entirely beyond the reach of our therapeutic agents,
(as for instance in cancer of the uterus determining nervous pains,) we must
content ourselves with the administration of such palliatives as we may possess.
If the disease still persists after the removal of the cause which produced it;
or should the cause escape our means of investigation; or the attack be of re-
cent occurrence, or even chronic in robust subjects, and sometimes also in per-
sons of a nervous temperament; it will be well, before resorting to any other
method of treatment, to try the effect of antiphlogistic remedies. The extent
to which these should be carried, must of course depend upon the quantity of
blood the patient can afford to lose; which circumstance may be determined
by an examination of his arteries, veins, and capillary circulation, and by the
percussion of such organs as are highly vascular, and capable of containing
large quantities of blood. General blood-letting which proved so successful in
the hands of Cotugno, may occasionally be resorted to; but copious local de-
pletion effected by the application of a large number of leeches along the
course of the affected nerve, together v/ith rest and poultices, repeated pro re
nata, is the course of treatment usually pursued in this stage. Those who doubt
the efficacy of sanguine evacuations in such cases, have either not properly
studied their effects, or have seen them employed with too much rashness, or
■with too great timidity. What have we to fear from blood-letting? Is it the
momentary debility which it produces? If the precautions which we have
elsewhere indicated are observed, the syncope can never become so excessive
as to prove dangerous. (Vide Procede Oper. de la Percussion, &c.-p. 249.) Is it con-
secutive debility? If, in the first instance, we do not establish in the system a
dangerous degree of debility, by extracting too large a quantity of blood, is
there any reason why we should anticipate the occurrence of a consecutive one?
Is it the tediousness of the convalescence? This will only take place when the
patient is confined to a vigorous diet. At La Pitie, where sanguine emissions
were carried to a great extent, but the patient at the same time properly
nourished, the transition from a state of disease to perfect health, was, in the
majority of cases, almost immediate. Moreover, the animals used in the experi-
ments on this subject, and from whom large quantities of blood were extracted,
speedily regained their usual quantity of this fluid. We should not, therefore,
doubt the importance of blood-letting in these cases, but it is true that it must
be conducted with prudence, and with a proper knowledge of its effects. In
the hands of those familiar with its powers, it can never prove dangerous; it
only becomes so when ordered by the inexperienced and rash. If the symptoms
are ameliorated by this plan of treatment, it should be continued; but we must
recollect, that although sanguine emissions when early prescribed are not ge-
nerally productive of danger, it is not so with those used at a later date. We
should, therefore, be guarded in ordering a repetition of this evacuation. These
remedies alone frequently prove sufficient to effect a radical cure. Wlien the
antiphlogistic remedies have been tried without success, and where the disease
does not manifest a tendency to assume an intermittent type, we may resort to
the application of vesicatories along the tract of the nerve, according to the plan
of Cotugno, which in his hands was very successful. The blister should be al-
lowed to remain but a short time in one spot, and must then be applied to
another in the neighbourhood. The form of the blister is also of some import-
ance. In general it should be long and narrow, so as to apply itself to tlie part
of the nerve. Almost every practitioner has witnessed the success of this
remedy. In several instances, however, the blister has failed to produce the
anticipated effect; we may here denude the cutis of its cuticle, and resort to the
endermic method of medication. The narcotics, for instance, the acetate, and
Practice of Medicine. 249
particularly the hydrochlorate of morphia, the stramonium, belladonna, henbane,
&c. may all be resorted to. In some cases we have found this method prove
exceedingly useful, in others again it has entirely failed. A woman of the Sal-
petriere had complained for several days of an acute pain in the temple, which
seemed to be neuralgic in its character; a blister was ordered to be applied to
the part, for the purpose of removing the cuticle, and the denuded cutis to be
sprinkled over with a grain of the hydrochlorate of morphia. The day after the
application of the blister, the patient expressed himself as entirely relieved. All
the benefit derived was attributed to the application of the opium; it was found
afterwards, however, that the opium had not been applied, and that the blister
alone had effected the cure. To avoid for the future, attributing to the absorp-
tion of some remedy, that which is due to the operation of the blister alone, it
would be well to apply the blister in a strip of about two lines breadth, and
then place the narcotic upon the denuded surface, which of course will be ex-
ceedingly small. When the narcotic, opium, for instance, has failed when ap-
plied externally in producing its effects, we may exhibit it internally, either in
the shape of an enema, or in a draught. These means, however, though they
generally produce a momentary alleviation of the symptoms, rarely effect a ra-
dical cure. Should the symptoms appear periodically — whether after the lapse
of a day or of several weeks, or of several hours, or even less time; if from the
influence of sanguine emissions, the disease changes from a continued, with occa-
sional exacerbations, to an intermittent form, we may resort to the administra-
tion of the sulphate of quinine in large doses, as if it were a case of intermit-
tent fever! We must not trust to small doses, but give it in doses of ten, fifteen,
and twenty grains; the largest dose being given immediately after the occur-
rence of the attack. If the succeeding paroxysms should be milder in their cha-
racter, or the interval between them increased, we may either continue in larger
doses the sulphate of quinine, or suspend its employment for several days, in
order to be able to resort to it suddenly in very large quantities. In some cases
it has seemed to me, that a repetition of the local sanguine emission during the
paroxysm has been productive of benefit; and that the sulphate of quinine ad-
ministered immediately afterwards operated more efficaciously upon the ap-
proaching attack. In cases of amenia, where the skin and lips are pale, and in
young women whose organs contain but little blood, the sub-carbonate of iron
sometimes produces the most happy effects, particularly in cases accompanied
with irregular menstruation, and where the menstrual blood is paler than usual.
Here we must be very cautious how we prescribe sanguine depletion. As the
brain, in cases of syncope and anemia, frequently exhibits symptoms precise-
ly similar to those produced by a congestion of its substance, in like manner
m.ay the nerves, in cases where there exists a deficiency of blood in the system,
should they perchance become irritated, be accompanied by all the symptoms
of irritation with congestion. When all our means have failed, and the treat-
ment founded upon rational views of the disease proved unsuccessful, we might
then have recourse to empirical remedies. The best to commence with are
those which are supposed to operate with most safety to the patient. The pills
of Meglin have sometimes proved useful; the essential oil of turpentine has also
produced beneficial effects in the practice of M. Martinet. Finally, cauteriza-
tion of the nerve, as practised by Andre, or its section which Galen is said to
have resorted to, and which Nuck so highly recommends, and which in the
hands of MM. Marechal, Louis, Pouteau, Guerin and Delpech, has produced
such varied effects, may be tried. Several very interesting observations upon
this latter method of treatment, as well as many important facts in the history
of the neuralgia's, will be found in a very reraarlcable and exceedingly erudite
memoir, that has just been pubhshed by M. Halliday.— Gaz. M^d. de Faris,
February 2d, 1833.
32. Efficacy of Madar, Cthe powdered Bark of the Root of the Asclepias glgan-^
teat J in Extensive and Obstinate Ulcers in Native Patients.-^A letter from J, L.
250 QUARTERLY PERISCOPE.
Gebdes, Esq. Assistant Surgeon, Madras Service, was read at the Society's
meeting- on the 4th Feb. 1832, containing the statement of a case in which the
madar had proved remarkably successful in the cure of an obstinate ulcer. The
patient was a Sipahee, of an Infantry Corps, who appeared to be of a scrofulous
diathesis. The disease had existed for a year, and the patient had been at Masuli-
patam six months, to try the effects of change of air, before he came under Mr.
Geddes' care. All former treatment had failed. The ulcer was of an unhealthy
appearance; situated on the upper and outer part of the left hip, extending
from the trochanter major, over the situation of the gluteus maximus muscle,
in a circular form, being in circumference upwards of sixteen inches. The ma-
dar was administered in pills, in the dose of four grains, three times a day. By
the time that a drachm and a half of the medicine had been taken, the sore as-
sumed a healthy aspect, and beg-an to cicatrize. After a few days there appear-
ed some disposition at the upper part (where cicatrization had taken place) to
ulcerate again. The madar was continued until another drachm was taken, and
the sore was completely cured. The medicine did not appear to produce any
effect on the constitution, except causing the sore to heal. No other remedy,
either external or internal, was used at the same time with the madar, except
a little simple ointment, which was spread over the surface, to prevent abra-
sions of the newly-formed skin; and a purgative was occasionally administered,
so that the efficacy of the remedy was unquestionable,
A letter from Dr. H. Mackenzie was read at the Society's meeting, on the
od of December, 1831, relating the case of a native boy, of Sandoway, aged 13
years, who had been ill about twelvemonths with inveterate ulcers. The bones
of the left forearm were bare and in a state of caries; there were numerous ul-
cers affording a very profuse discharge, and sinuses about the forearm and el-
bow; the patient was miserably reduced, and unable to stand; he had tried all
the ordinary resources of the district without benefit. The madar powder was
given twice daily, at first in doses of two grains, and afterwards gradually in-
creased to five grains, twice a day; in which quantity it produced uneasiness
and a disturbed state of the bowels; therefore the dose was reduced to three
grains. The beneficial effects of this medicine were very evident in a few days:
at the end of a week the boy's health was decidedly improved, and the profuse
discharges from the ulcers had decreased; the decayed portions of bone were
then extracted. At the end of five weeks from the time he began to take the
madar, all the sores had healed, and the boy was able to walk about. Dr. Mac-
kenzie ascribes the early improvement of this boy's health, and his ultimate re-
covery, to the *' restorative and invigorating properties of small doses of madar;
which remedy was left to produce its individual effects, without the exhibition
of any other medicine, capable of modifying them in any degree." — Transac-
tions of the Medical and Physical Society of Calcutta, Vol. VI.
SURGERY.
33. Extirpation of a Necrosed Clavicle, followed hy complete Reproduction of the
Bone. By Dr. Mkyeu, Surgeon to the Hospital of Zurich. — Cases in which com-
plete reproduction of the bone follows the excision of a diseased clavicle, are
of extremely rare occurrence. Windmann mentions but one instance of the
kind, Meyer two, and Mott one. The following observation is therefore im-
portant.
G. Menne, aet. 31, of a feeble constitution, had been subject from infancy to
scrofulous ulcerations of the neck. In .June, 1823, he was seized with violent
pains, resembling the rheumatic in the right arm, for which he was treated by
several physicians, but without any relief being obtained. The pain continued
to increase; and finally, whilst on a visit to the baths of Baden, a tumour formed
in the right axilla, which opened of its own accord, and from which an acrid,
Surgery. ^ 251
ichorous fluid was discharged. General debihty now supervened; his appetite
disappeared; in short, all the symptoms of hectic developed themselves, and he
was received into the Hospital of Zuricli in the following- condition, on the 8th
of October, 1823. Great emaciation; feeble appetite; sleep imperfect, and fre-
quently interrupted by violent cough, and hectic fever. An ill-conditioned
ulcer existed opposite the acromial extremity of the clavicle, which bone was
in part denuded. The probe penetrated readily about an inch along the upper
face of the clavicle, which was found rough and uneven to the touch. In the
centre of the sternum there existed a fistulous orifice, through which a probe
might be passed from below upwards about an inch; the bone however was in a
sound condition. Finally, a fluctuating tumour was discovered between the
eye-brows. Yor fourteen days tonic remedies internally administered, accom-
panied at the same time by frictions, with volatile liniments, were prescribed.
The ulcer was dressed with charpie soaked in tinct. of myrrh, and the bone
moved daily with the forceps. The forces of the patient by these means im-
proved; his appetite and sleep returned; the fever became less intense; the
cough not so harassing; in short, he was so much improved, that I ventured to
lay bare, by an incision, the acromial extremity of the clavicle, and extract a
small portion of it with the forceps. By this means the acromial extremity was
more completely exposed, and an attentive examination showed that the bone
was denuded as far as its centre. About the fifteenth day the bone seemed to
be a little looser, though it appeared nevertheless to be firmly united with the
surrounding soft parts; its sternal extremity was also still strongly held by its
capsule. At this time the constitutional symptoms increased in violence so ra-
pidly, that I determined to operate at once.
The patient's arm being drawn forcibly forwards, in order to separate the
clavicle as much as possible from the vessels which course along its posterior
and inferior surfaces, I proceeded to divide with the bistoury the integuments
and muscular fibres covering the anterior and inferior margins of this bone, then
drawing it, (the clavicle,) as much as possible forwards, 1 separated it, partly
with the fingers, and partly with the knife, from its connexions behind and
above. I next proceeded to open the capsule of the sternal articulation, in
doing which, whilst drawing the bone forcibly forward, the latter snapped off
near its sternal extremity; the fragment which remained attached to the ster-
num was however easily separated from its adhesions and extracted. The ope-
ration oocupied about five minutes, and was accompanied by little or no haemor-
rhage. The patient already exceedingly feeble, sank into a state of exhaustion,
from which however he was recalled by the administration of stimulants, &c.
On the third day after the operation, suppuration of a healthy character esta-
blished itself, and in the course of seven weeks the wound was completely ci-
catrized. After a time the tumour on the forehead was opened, and the bone
found to be in a carious condition. This, however, as well as the fistulous
orifice of the sternum, was in a short time cured. By degrees the patient's
general health was reestablished; the arm resumed its natural position; and in
place of the clavicle extracted, a bone of recent formation, having precisely
the form of a healthy clavicle, though apparently more delicate than natural,
could be distinctly felt occupying the position of the original bone. He could
also execute with the arm all the motions of circumduction, and daily employed
himself in some manual labour. Up to 1828, the patient was enabled to attend
to his aff*airs; at this period he was attacked with a pulmonary affection that
carried him off in a short time.
Autopsy. — Between the clavicular socket in the sternum, and the point and
superior margin of the acromion, there existed a fibrous, almost cartilaginous
ligament, containing several ossified points, upon which rested the inferior sur-
face of the recently-formed clavicle. The space comprised between these
two points, and occupied by the ligament just mentioned, was four inches six
lines in length. The new bone was three inches ten lines in length, delicate,
flattened towards the sternum, and more rounded towards its acromial end.
252 QUARTERLY PERISCOPE.
The sternal extremity was larg-er and thicker, and united itself to the corres*
ponding sternal facet by a well-marked articulating head. The bone terminated
about an inch from the acromion in a thick apophysis, between which and the
acromion there extended a broad, thick ligament, containing several ossified
spots. The upper border of the clavicle was convex towards the sternum, con-
cave towards acromian, and well-rounded throughout. The inferior margin, on
the contrary, was rough and studded with small ossified points, which projected
into the ligament below.
The autlior assigns as the organ of reproduction in this case the periosteum
of the old bone, notwithstanding it had also undergone some morbid alteration
from the effects of the disease.— Gaz. Med. de Paris, Sept. 2Sth, 1833, from Graefe
und Walter's Journal.
34. Reduction of a Double Luxation of the Inferior Maxillary Bone, thirty -Jive days
after the occurrence of the Accident, effected by a New Method of Treatment. By Dr.
Strometer.— The mstrument invented by Dr. Stromeyer for this case, resembles
very much a pair of strong steel forceps, the branches of which, instead of
crossing each other as usual, are united at one end by means of a screw. This
is so arranged, that whilst the ends containing the screw are made to approxi-
mate, by turning the latter, the other extremities will be separated from each
other in proportion to the number of times the screw is turned. These termi-
nate in two oval plates, (one for each branch,) covered with thick leather,
which are intended to be placed upon the last molars of the two maxillary
bones; when these are made to separate by means of the screw fixed in the
other extremities, the bones of course will be forced asunder. The extremity
of the screw is attached to the inferior branch of the forceps by means of an-
other, which limits the degree of pressure exerted by the former; so that,
should the force applied be found too great, it maybe removed instantaneously
and completely by merely turning the regulating screw. The following inter-
esting observation will serve to explain the modus operandi of this very inge-
nious instruntient.
Observation. — Amolie Eisner d'Elz, domestic, aet. 23, luxated the inferior
maxillary bone on both sides in gaping. The accident occurred on the 7th of
May, 1819. The physician of the family mistaking the nature of the case, treated
ber with opiates, frictions, sinapisms, &c. Another physician was called in, who
recognised at once the nature of the accident, and attempted the reduction of
the dislocation, in which operation he was assisted by three or four others, who
had been called in to witness the case. Every attempt, however, failed to pro-
duce the desired effect, I now determined to make use of my instrument, with
the design of breaking up any adhesions which the condyles might have formed
with the surrounding parts, and of overcoming afterwards the resistance of the
muscles by fatiguing them. Thirty-five days elapsed since the occurrence of
the accident, and the inferior dental arch projected a little more than half an
inch beyond the superior; they were, moreover, separated from each other at
least an inch. The lips could, notwithstanding, be brought in contact with each
other, and her voice had nearly acquired its original distinctness. Mastication
alone was but imperfectly performed, the last molar teeth being the only ones
engaged in it; deglutition remained unimpaired. The depression before the
ears was well marked; and the swelling having entirely disappeared, the con-
dyles could be distinctly felt in their new situation.
The instrument was introduced into the mouth, closed, and in such a man-
ner that the oval plate of the upper branch rested behind the last molar teeth
of the superior maxillary bone. The two branches were then separated, by
turning the screw, at first rapidly, and then more graduall)'', in proportion as
the resistance increased, restmg a i'aw seconds between each rotation of the
screw until the pains produced had ceased. The last turn given the screw caused
a peculiar cracking noise, as if the adhesions had suddenly given way. As the
space between the two branches of the speculum, already equalled three-
Surgery. 253
quarters of an inch, the least turn of the screw produced the most violent pain;
I therefore determined to stop the extension, leaving-, however, the instrument
in its present condition for some time. The whole time it was in operation was
about one-quarter of an hour; I then closed it suddenly by unscrewing the
reg-ulating" screw, and withdrew it from the mouth as quickly as possible.
Dr. Wellhausen, who assisted me, now introduced his thumbs, previous-
ly enveloped in a piece of roller, in the mouth, and made use of the or-
dinary manoeuvre for the reduction of this dislocation, whilst I pressed
upon the heads of the condyles to favour their retrocession. The reduction
was effected without being- accompanied by the sudden or spasmodic closing of
the maxillary bones, and owing- to tiie relaxed condition nf tlie muscles, the in-
ferior dental arch still remained a little in advance oitlie superior; in the course
of a few hours, however, a great amelioration in this respect took place, and a
few days were sufficient to eradicate every vestige of deformity. The inferior
dental arch regained its original position, and the patient recovered the entire
use of the lower jaw. No relapse occurred. — Gazette Medicate de Paris, Sept.
28thy 1833.
35. Operation for Strangulated Inguinal Hernia, performed on an Infant eight
days old. — An example of this is recorded by Dr. Heyfelber, in the Trans-
actions Medicates, for April, 1833. After the operation the child appeared re-
lieved, but six days afterwards it was suddenly attacked with convulsions, which
were succeeded by trismus, and the patient died. On examination, the intes-
tines in the ileo-coecal region were sphacelated and perforated. The strangulation
had existed tliree days before the operation was performed, the delay during
the last twenty-four hours having been caused by the parents.
36. Ligature of the Subclavian Artery below the Clavicle. — A young man re-
ceived a sword-thrust through the folds of the axilla, in a duel. The hemorrhage
was checked by compression, and in eight days the wound was nearly healed?
but now unfortunately the bleeding returned, and although restrained for the
time broke out afresh at different intervals. Professor Blasius of Halle determin-
ed therefore to tie the subclavian artery, below the clavicle. The operation
was performed on the 20th day after the accident; and although no particular
difficulty was experienced in any of the steps, the patient had been so exhaust-
ed by the repeated losses of blood, that he died on the 2d day after. On
dissection, the axillary artery and vein were found uninjured; the source of
the bleeding had been from the circumflexa humeri posterior, and circum-
flexa scapulee, the wound having penetrated from behind, through the tendon
of the latissimus dorsi, upwards and forwards. The subclavian artery, at the
point of the ligature, was well secured.
Dr. B. very correctly condemns in severe terms the early treatment of this
case. Why was the artery not laid bare at once, and a thread passed round it?
No time should be lost upon such an occasion; the delay of even six, twelve or
eighteen hours may be most injurious; for if an inflammatory action, nay an in-
flammatory tendency be established around the wounded vessel, the risk of se-
condary haemorrhage is tenfold increased. Dr. B. was called one evening to a
young man, who had wounded his hand deeply in the morning; a bungling sur-
geon, who had seen the patient then, had crammed compresses and other trash
into and upon the wound; a certain degree of inflammation had thereby already
commenced, when Dr. B. applied the ligature; on the 4th day, the vessel liad
ulcerated; tlie bleeding returned; and a second operation was necessary. But
should the wound heal partially at first, and the haemorrhage not recur, till the
16th, 18th, or 20th day after the accident, when suppuration had been established
for some time, not only are the difficulties of securing the injured vessel greatly
increased, but also the chances of ulceration of its coats at the site of the ligature
and consequent bleeding. The parts are much changed in their tissue, and are
matted together, so that it is often not easy to distinguish between them; and
moreover the arterv is so glued to its sheath, &c. that it is scarcely possible to
No. XXYIL—Mav. 18S4, 22
254 QUARTERLY PERISCOPE.
isolate it satisfactorily. Still with all these disadvantag-es, the tying of the artery
is much safer than the employment of any other styptic remedies; our prognosis
however cannot be so favourable, as it would have been, after an earlier ope-
ration.— Bust's Magazine.
37. On Sanguineous Tumours of the Cranium. — The most common and least
dangerous sort of these bloody swellings is when the blood is effused between
the aponeurosis of the occipito-frontalis muscle, and the common integuments. —
They are very often observed on the heads of new-born infants, and are no
doubt caused by the severe contusion of the cranium, during its expulsion
through the pelvis. This is the "caput succedaneum'^ of some German authors.
In general, it may be easily discussed under the use of resolvent applications.
The second variety of bloody tumours of the scalp, and which is usually caused
by contusions or other external violence, is that which has been described by
M. Zeller under the name of cephalsematomie. The blood is diffused between
the aponeurosis and pericranium. The German and Italian writers have often
confounded this variety with the former; — it is only on this supposition, that we
can account for their differences of opinion wilh respect to the danger or not
of these bloody sweUings, and to the treatment which they have recommended;
some advising the knife to be used, others trusting to discutient lotions.
The fluctuation is not so distinct as in the first-mentioned kind, and the blood
becomes diffused more readily, so that it does not generally present the appear-
ance of a depression in the centre, and an elevated hardened border round;
signs which have sometimes led surgeons to suppose that there was a depressed
fracture of the bone, when the effects of the bruise were nothing but an ecchy-
mosed subcutaneous swelling. In this sort the aponeurosis sometimes form a
solid cyst round the extravasated blood. Whenever the pericranium becomes
detached from the skull the injury assumes a more grave importance; — we can-
not with certainty predict that the bone may not become idtimately necrosed.
But this is rare, and authors have no doubt often committed the error of suppos-
ing that the blood was in contact with the bones, when the investing membrane
of the latter was quite entire and firmly adhering.
M. Velpeau mentions a case of a child, only ten days old, being brought to
him for a supposed hernia of the brain.
A soft fluctuating tumour covered the greater part of the left parietal, part of
the temporal, and almost the whole of the occipital bone. The dispersion of
this swelling was easily effected in the course of a few days. It is quite an un-
usual occurrence, that the pericranium is detached from the bone in new-born
infants, however difficult the delivery may have been, and however large the
quantity of blood effused. Sometimes, indeed, when a true encephalocele does
exist, we meet with bloody swellings, which have their seat next to the bone,
on others parts of the head; — such cases are very generally fatal.
The third species of swelling is situated deeper than either of the preceding
two. Chelius, in his manual of Surgery, published in 1827 at Heidelberg, places it
in the diploe of the bones; M. Velpeau thinks that it mure frequently begins
between the bone and the dura mater, although a case mentioned to him by M.
Lauth is more favourable to the other opinion. A man received a blow with a
cudgel on the parietal bone; but little notice was taken of it, and in the course
of a few days he appeared to have quite recovered. Several months after se-
vere pains were felt in the part diametrically opposite; (are we to understand
the parietal bone of the other side?) and it was judged proper to trephine the
bone there; but no correct information as to the true nature of the disease was
obtained by the operation. After death, a fungoid mass was discovered, of the
size of a large walnut, flattened, and, as it were, encysted in the diploe of the
bone, where the blow had been received.
M. Velpeau has seen two cases in which blood was effused between the dura
mater and bone during accouchement. It is very probable that the blood re-
tained in this situation may undergo certain changes and ultimately give rise to
some of the cranial fungoid tumours. — Journal Hehdomadaire.
Surgery. 255
38. Case of Compound Fracture of the Thigh, in ivhich Amptdation was Per-
formed. By R. N. BuRN-ABD. — The subject of this case was a boy, about 12 years
of ag-e, whoj by a fall from a tree, had sustained a severe compound fracture of
the right thigh, about one and a half or two inches below the trochanters. The
accident had happened twenty days previous to his admission into the hospital
on the 25th January, 1830, when Mr Burnard saw him for the first time. The
whole of the leg at this time was in a state of mortification, the gastrocnemii
muscles detached from their superior attachment, and the back of the knee joint
exposed; the fleshy part of the thigh below the fracture was in the same state
of mortification, with the exception of a small portion on the inside, which alone
connected the dead mass to the living. Above the fracture there was a small
extension of mortification, but there appeared no disposition for it to spread
higher, and nearly the whole of the parts affected could be included in the in-
cisions for forming the flaps. It was immediately determined to amputate the
limb at the hip-joint, which was accomplished as follows: — Mr. Burnard having
no assistants excepting his native Doctors, commenced by cutting down on the
artery immediately where it emerges, from beneath Poupart's ligament.
Having secured this by a single ligature, the knife with one stroke was directed
through the connecting" part in the inside, by which the operator got rid of the
embarrassment of the limb, and then grasping the upper portion of the bone,
abducted it as strongly as he could with one hand, while with the other, a cat-
line was carried along it into the joint and round the head of the bone. The
dislocation was easily efi'ected, and the attachment of the muscle severed by
carrying the knife round close to the bone; and after its removal two flaps were
formed by cutting- outwards, and inwards from the original incision made to se-
cure the artery, and as far as possible including" all the parts aflTected with spha-
celus or threatened with it. Four small arterial branches required ligatures,
but the whole haemorrhage did not exceed three or four ounces, and the flaps
were brought together by three sutures, adhesive straps, compress and roller
being afterwards applied. The operation and dressing occupied about 20 mi-
nutes; the patient bore it with great fortitude, and when returned to his bed
appeared but little exhausted. On the evening of the 26th, symptoms of teta-
nus came on, and pursued the usual course to the destruction of the patient; on
the morning" of the 28th he expired. — Trans, of Med. and Phys. Sue. Calcutta,
Vol. VI.
39. Stricture of the Rectum treated by the Introduction of a Tent, hy a New
Process. By M. Tanchou. — That there exists great analogy between stercoral
and urinary fistulae is not disputed; the following observation is a new proof of
the correctness of this opinion. It also shows that the eflforts of nature alone,
are sometimes adequate to a cure; and that the formation of an artificial anus
should be attempted, in all cases of either complete obliteration of the rectum,
or of contraction of this gut to such a degree, as to prevent the escape of fjecal
matter. It moreover proves, that the occurrence of a fistula, or the perform-
ance of this operation, are means by which the days of those affected with
stricture of the rectum may at least be prolonged, though they may fail in pro-
ducing a radical cure.
Case. — Stricture of the rectum,- stercoral fistulx causedhy a gangrene ofthebreech,-
one ofthefistulx completely healed; a disposition to a complete cure brought about. —
Madame M. a:t. 55, of a strong constitution naturally, and considerable embon-
point, was attacked in 1830 with a violent inflammation of the bowels. She was
treated upon the antiphlogistic plan. During convalescence she indulged her
appetite too freely, which brought on an attack of indigestion; in consequence
of this her restoration to health was slow and imperfect, indeed it seems she
never acquired her original sound constitution. In the beginning" of 1831 she
visited Angouleme, where she delivered herself up entirely to the dictates of
her morbid and sensual appetite. In a short time she was seized with a diarrhoea,
accompanied by colic and flatulency. This increased to such an extent that
she had as many as forty or fifty evacuations during the twenty -four hours; to
256 QUARTERLY PERISCOPE.
this condition of things was soon added a constant tenesmus, which obliged her
to remain almost the whole time upon the close-stool. These symptoms
gradually abated, without her pursuing in fact, any method of treatment; that
is to say the stools were less frequent, and occasionally she was even constipat-
ed, though when this was relieved she would be attacked with violent diarrhcea
and severe colic. In this condition she set out on her return to Paris, where
she arrived after an extremely fatiguing and hazardous journey in the month of
April, 1832; I found her very much changed in appearance, she had completely
lost her embonpoint, and was very pale. Hei' abdomen was also considerably
swollen, and she suffered from the most violent colics accompanied with a con-
stant desire to visit the close-stool. Her attempts to evacuate were either entirely
nugatory, or followed by a discharge of slimy fa;cal matter, or of an extremely
foetid fluid. She still refused, as formerly, to submit to any regular treatment,
particularly to a rigid course of diet. Her symptoms still increasing in violence,
I determined to examine the rectum, in doing which I discovered that the an-
terior portion of this gut, about three or four inches above the sphincter, had
undergone considerable contraction; its posterior face appeared to be as yet
in a healthy condition. I insisted anew upon her observance of a rigid diet,
and prescribed the application of leeches to the breech, with the design of
subduing the inflammation, so that a tent might be introduced; but my orders
were but partially obeyed. MM. Roux and Majendie were now called in, both
of whom confirmed my diagnosis, and recommended a strict attention to the
treatment which I had prescribed. Notwithstanding all this, she persevered in
indulging her appetite, and could not, or would not allow the tent to remain in
the rectum but a few hours at a time, and occasionally passed whole days to-
gether without its being introduced at all. The disease still continued to in-
crease, and the cavity of the gut became smaller and smaller. By degrees she
became more and more feeble; emaciation increased rapidly; her complexion
became straw-coloured; her abdomen remained swollen, and she evidently suf-
fered from a retention of faeces. Enemata brought away nothing; and finally,
the stricture of the rectum increased to such a degree that nothing but liquids
could pass through it. She also suffered intensely from colics and tenesmus.
Such was the condition of the patient in the month of January, 1833. In the
month of June following, (all the above-mentioned symptoms having increased
in violence,) there appeared on the right buttock a swelling, which in a short
time acquired an immense size. It resembled indeed, very much, both in size
and shape, a small wash-hand basin. It imparted to the touch a doughy feel,
and was neither inflamed nor very sensible when pressed upon. At this period
she had no faecal evacuations at all. After a time a slight degree of redness
was observed upon the surface of the tumour, together with a sensation resem-
bling that produced by the pressure of a thin dough in the cavity of a sac, which
indicated either the existence of deep-seated suppuration, or the effusion of a
fluid. Positive fluctuation did not exist. The anxiety, fever, and state of des-
peration under which the patient at this time laboured; but more particularly
the supposition that the tumour was formed by a mass of extravasated faeces,
induced me to decide upon making an incision into it; accordingly one three
inches in length, and corresponding in direction with the apex of the buttock,
was made in its summit. This gave issue to a large quantity of very foetid gas,
faecal matter, and a small quantity of pus; these were not encysted or collected
in a mass, but seemed to be merely infiltrated. The patient was relieved, though
the swelling was not sensibly diminished. On the third day after the operation,
there appeared near the fold of the breech and thigh, a small gangrenous spot,
which in a short time increased to such an extent, as almost to touch the in-
cisions. Thinking it the better plan to lay open this mass, I continued the
first incision downwards for about three inches. The whole was then lightly
dressed, after having been previously washed with chloride of lime water. The
discharges from the wound were composed of faecal matter, mixed with pus,
and a gangrenous sanies. In a few days a large portion of the interior of the
buttock was attacked with gangrene, and a mass of sphacelated cellular tissue.
^ Surgery. 257
nearly equalling in size the two fists, presented itself between the lips of the
wound. This was washed in the chlorine solution, and then dusted over with
powdered tan-bark and quinine. The edges of the wound were dressed with
strips of linen spread with storax. During this treatment, and without doubt
by the efforts of nature alone, the gangrene ceased to progress; the margins of
the eschar were detached; the inner surface of the buttock sloughed off, and
there remained an ulcerated surface more than eight inches in diameter, and
deep enough to lodge the doubled fist, which terminated above in a stercoral
fistula large enough to allow the ready escape of the faecal matters. All the
symptoms produced by the retention of the faeces now ceased; the sleep became
again tranquil; the appetite returned; soups and light articles of diet were easily
evacuated; the fever diminished; the wound assumed a healthy appearance; gra-
nulations sprouted up from all sides; and on the 15th of August the sore had
diminished at least a third; its bottom was nearly on a level with the surface of
the skin; and to my great astonishment every thing indicated a speedy restora-
tion to health.
About this time a small tumour made its appearance between the sphincter
and coccyx, which soon opened; the orifice however was not sufficiently large
to allow the faeces to pass readily; I therefore enlarged it. The quantity of faeces
that were evacuated through the fistula, (nothing passed through the anus for
two months before this time,) now began to diminish; the abdomen, which had
returned nearly to its natural state, again became tense; the complexion, which
had regained its clear and rosy tint, became again pallid; the colics were more
frequent and violent, and she was at length obliged to keep her bed; in short,
all the symptoms dependent upon a retention of faeces reappeared. I now en-
larged the opening in the last tumour an inch and a half, directing the incision
along the coccyx, beheving that a division of the sphincter would be attended
by no beneficial result. This gave issue to a large quantity of faecal matter
and pus, that had collected in this new situation. From this time forward the
discharge from the original fistula daily diminished, until at length it ceased
entirely, and the wound nearly healed. The injections, which formerly were
discharged through several orifices, were now returned through the last incision
alone. In a word, the original fistula closed, and the course of the faeces seemed
to approach the natural direction. The appetite, spirits, and embonpoint of
the patient returned; she is also strong enough to walk in her garden, and
every thing leads us to conclude, that although a perfect cure of all her com-
plaints will not be effected, she will at least be left with merely the inconve-
nience of a stercoral fistula, which will not materially shorten her days. It may
even be possible, after the complete cicatrization of the breech, to unite the
anus to the remaining fistula, by dividing the barrier which separates the two
cavities from each other, provided this barrier is not of too great an extent,
and the point of communication between the fistula and cavity of the rectum is
attainable with the point of the finger. The patient would then be able, after
having suffered from gangrene of the breech, accompanied by several stercoral
fistulae, to evacuate her faeces per vias naturales! The manner in which the
tent was introduced into the rectum during the period that Madame M. con-
sented to its application, merits perhaps a particular notice. For the first few
days it was introduced in the form of a long conical cylinder, the point of which
passed through the anus, in order that this point of the gut might suffer the
least degree of pressure. But in a short time the rectum, from the combined
influence of the disease, and a thickening of its parietes, becoming changed
both in its shape and direction, it was found impossible to follow up its sinuosi-
ties except with a stilet. It occurred to me, that by mounting the tent in the
following manner, its introduction into the stricture' would be materially facili-
tated. I had made a little tube about an inch in length, the superior extremity
of which terminated in a sort of neck; its inferior extremity was conical, and
opened for the reception of a forked probe about six inches in length. The
tent, (meche,) supported in its middle by the neck of the tube, was so arranged
as to coyer the latter completely. In order to apply it, I first introduced a
22*
258 QUARTERLY PEHISCOPE.
long flexible probe into the rectum, and searched for the stricture. Having
found it, I passed up the tent by shoving' it along- the probe, which being held
in the stricture, and its lower extremity passed through tl\e cavity of the cylin-
der, served as a conductor to the point diseased. By this means the tent was
safely lodged beyond the point of stricture, without the operation being at-
tended by fatigue to the patient, and without any portion of the intestine, ex-
cept the point strictured, being subjected to any distention whatever. The
stilet and conductor were then withdrawn, and the tent left in the stricture.
The great advantage of this sort of meche is, that it permits the escape of flatus
which sometimes collects in large quantities in these cases, and which is pre-
vented from passing out by the tents usually made use of, which block up com-
pletely the cavity of the stricture. — Gaz. Med. de Paris, Sept. ^Sth, 1833.
MIDWIFERY.
40. Malposition of the Spinal column rendering Delivery impossible — Csesarean
section — Death. — Minotj a female, forty years of age, had been pregnant seven
times within the last twelve years. Her fifth and sixth pregnancies terminated
in abortion within the first three months. The rest had been all more or less
difficult, and only one child had been born alive. The application of the forceps
had been necessary in each labour; and at the last M. Capuron had been com-
pelled to turn the child and perforate the base of the skull. On the 3d of
February last, being pregnant for the eighth time, M. Bello was called upon to
see the woman, whom he found in the eighth month of pregnancy, having suf-
fered for seventy-two hours from pains in the loins, exactly similar to those
which preceded her other labours. When the patient was uncovered, M. Bello
found the abdomen of the woman hanging down completely between the thighs,
and covering the knees in such a manner, that the umbilicus, which formed the
most inferior point of the tumour, touched the thighs when the patient was in
the sitting posture. The anterior, or, rather, inferior, surface of the skin cover-
ing the abdomen, which was enormously distended, presented a very intense
purple redness, with some crusts and slight ulcerations. At the lower part, on
the left side, was noticed the trace of an old large cicatrix, and a little higher,
near the median line, an actual loss of substance, of the size of a franc piece,
produced by sloughing of the abdominal parietes. The bottom of the escharous
ulcer was formed by a smooth, thin, transparent membrane, which was recog-
nised to be the peritoneum. The termination of the former labours, the state
of the abdominal parietes, and the extreme deviation of the uterus from its na-
tural position, did not leave any hope of the next delivery being terminated
without the assistance of art; and it was readily agreed by four physicians who
were present, that something should be done before the labour-pains had fur-
ther reduced the strength of the patient. The application of the forceps was
impracticable, because every attempt made to return the uterus to its natural
position, and bring the foetus to the inlet of the pelvis, occasioned the most
violent pains, whilst version was judged equally impossible, because the toucher
could not discover the os uteri, which seemed more elevated than the fundus.
Finally, symphyseotomy, which, besides being little applicable to the peculiar
case in question, was excluded by the manner in which the abdomen covered
the pelvic arch. The Caesarean operation was therefore, decided on, and per-
formed on the next day, 4th of February, 1833, by M. Baudelocque. A longi-
tudinal incision of five inches in extent was made along the median line of the
bottom of the tumour; the first stroke of the bistoury, although carried to the
depth of a line, only exposed the uterus, and the operation was finished in six-
teen minutes without the patient complaining of the least pain. The infant, ex-
tracted alive, was feeble, and imperfectly developed; it lived only for seventeen
liours; a very small quantity of blood was lost during the operation, and a faint-
ing fit by which it was succeeded, was attributed to maternal emotion. The
patient was replaced in bed, and expired fifteen hours after the operation.
Midwifery. 259
Atiiopsy eight hours after death. — The face and whole cutaneous surface of the
body were remarkably pale; the cavity of the pelvis and a part of the abdomen
were filled with clots of blood; the uterus, in a moderate state of contraction,
also contained some clots. The dimensions of the pelvis were taken with accu-
racy. The antero-posterior diameter of the inlet was four inches eight lines;
the transverse was four inches nine lines; the oblique diameters were four inches
four lines. The outlet of the pelvis was not equally well formed; the antero-
posterior diameter had four inches two lines; but the transverse diameter was
contracted to two inches nine lines.
The disposition of the vertebral column explained perfectly the difficulties
of the labour. From the occiput to the sacrum it was perfectly straig-ht, with-
out curve, and was united to the anterior part of the sacrum at a right angle, in
such a way, that when the woman sat down, the base of sustentation was not
formed by the sciatic tuberosities, but by the posterior surface of the sacrum;
when she walked, the legs were slightly bent, the trunk was forcibly thrown
forwards and to the left side, the shoulders and elbows were carried backwards,
and the head was in a forced state of extension, and directed upwards, so that
her acquaintances used to compare her manner of walking to that of a stag.
This disposition of the vertebral column of necessity threw the abdomen for-
wards and downwards, and cut the plane of the inlet of the pelvis into two
parts, the larger of which gave only a diameter of two and a half inches, and it
was, in fact, this diameter which the foetus would have had to traverse during labour.
It does not appear that this species of malformation has been before noticed
by authors amongst the causes which may render labour either difficult or im-
possible. The woman attributed her deformity to a fiill which she had at the
age often years, and to a disease which seemed consequent on it; this affection
was in all probability caries of the vertebrae, which had removed the body of
one of the lumbar vertebrae, for on examination there were only found four on
the anterior surface oFthe column, though the posterior surface presented five
distinct lumbar spinous processes. The patient evidently died of haemorrhage,
the occurrence of which M. Bello accounts for, by saying the incision into the
uterus was made at the point corresponding with the insertion of the placenta :
hence, he concludes it will be proper under similar circumstances to apply the
stethoscope before the operation, in order to discover the insertion of the pla-
centa, which may thus be avoided. — IVans. Med. Sept. 1833.
41. New Method for the Division of the Pelvis in cases of Difficult Parturition. —
' This operation, which consists in dividing the horizontal branch of the pubis, on
both sides, above the obturator foramen, was originally conceived by Aiken,
and first performed by Galbiati, a celebrated accoucheur of Naples, in March,
1832. The following detailed account of this operation, which we copy from
the Lancet, is taken from // Filatre-sibezio, 1833.
G. Negri, of Naples, of good health, and at present of sound constitution,
was rachitic to such a degree, that her stature did not exceed two and a half
feet: the lower extremities were extremely deformed, and the pelvis was so
vitiated, that the promontory of the sacrum approached within an inch and a
quarter of the pubis. She had been pregnant twice before this period, and
succeeded in bringing on abortion in the early months; but having become
pregnant again at the age of thirty, similar attempts to bring on abortion failed,
and she entered the hospital, fully convinced of the impossibility of being deli-
vered in the ordinary way. The necessity of an operation was at once visible,
and the method of Dr. Galbiati discussed: new trials were made on the dead
body, care having been previously taken to inject the arteries of the pelvis.
The operation seemed easy of execution; no important parts, vessels, or nerves,
were injured, and although the diameters of the pelvis were artificially reduced
to those which the pelvis of the patient presented, the hand could be introduced,
and a body as long as the head of a child extracted. A numerous consultation
of the professors of the school of Naples was now held; the opinions were va-
riousj some rejected the proposed operation altogether. Others preferred the
260 QUARTERLY PERISCOPE.
Csesarean section; but the greater part of the surgeons and accoucheurs present
decided in favour of the new method, as soon as the first pains of labour should
appear. On the 30th of March, at day-break, the pains came on: they continued
increasing to the middle of the day, when the operation would have been per-
formed, but the consent of the patient could not be obtained before six o'clock
in the evening, when the uterine pains Vv^ere rare and feeble. Before proceed-
ing to the operation, M. Galbiati explained to those present, that when the
antero-posterior diameter had one inch of extent, it was necessary to divide the
pubis on one side only: that it required a still greater contraction of the inlet of
the pelvis to render the double section indispensable, and that the case before
them was of the first kind. Besides, as the inclination of the promontory of the
sacrum to the left gave more space on the right side of the pelvis, it was proper
to take advantage of that circumstance, and operate on the right side: finally,
as the strength of the woman was not reduced, it would be right to permit the
uterus to act for some time longer on the child's head.
The operation was commenced by a longitudinal incision of an inch and a
half, which exposed the horizontal branch of the pubis, on the right side, as
near as possible to the cotyloid cavity; the periosteum was detached by means
of a concave scraper, and the bone divided; the ascending branch of the ischium
was divided in the same manner, and the operation terminated by symphyseo-
tomy: the operation lasted an hour and a quarter, but was performed without
the occurrence of any accident: the patient did not seem to suffer much, and
shortly after its termination the waters came away; the expulsion of the child
was now left to nature. Four hours after the operation the patient was put into
a warm-bath, during which the uterine contractions became more frequent and
powerful: a moderate dose of secale cornutum was administered, but immediate-
ly rejected by vomiting. The patient passed a quiet night; in the morning the
countenance was nearly natural, the pulse a little disturbed, tongue moist; ab-
domen free from pain, and uterus contracted upon the foetus; the pains still re-
mained feeble and rare; the finger could barely touch the head of the foetus, ex-
tremely high in the pelvis. The warm-bath was repeated twice in the course
of the day without any effect, the contractions of the uterus remaining in the
same state; during the night they were equally feeble. On the second day the
face was natural; pulse feverish; tongue red and dry; the belly a little swollen,
and slightly painful; the head of the child could be felt more distinctly, but it
had not at all descended into the cavity of the pelvis. In this state of things,
a new consultation was held, and it was resolved to divide the horizontal branch
of the pubis on the left side, and to have recourse either to version or the for-
ceps, as no result could be expected from the feeble condition of the mother.
The patient at first refused to consent to this new operation, but agreed to sub-
mit at four o'clock in the evening. The operation was performed in the same
way as that already described, and the head of the child, which was not at all
engaged, was seized with the forceps, and brought down into the cavity of the
pelvis, where it was left: the finger ascertained that the cranium had given w^ay;
and the parietal bones, which were detached from the rest of the skull, were
easily extracted. As the death of the foetus was now certain, the remainder of
the brain was evacuated, and the foetus easily extracted by the hand; there
were two circles of the umbilical cord attached round its neck; the skin was
so little altered, as to give rise to the opinion that the child was alive on the
evening before. Although the manoeuvres necessary for the extraction of the
child did not last more than half an hour, and were performed with the utmost
delicacy and caution, the patient immediately fell into such a state of prostra-
tion, that she seemed on the point of expiring; her countenance was cadaverous,
the pulse insensible, and the body covered with a cold sweat. The means
proper to revive and support her were immediately employed, and she passed
a pretty tranquil night; in the morning the tongue was red and dry, and the
pulse had ralUed a little, but the abtlomen was painful and tympanitic; a very
fetid sanies was discharged from the vagina, and the patient expired during the
night.
Midwifery. 261
Autopsy. — The external genital organs were livid, and the wounds gangre-
nous: the anterior portion of the vagina was healthy, but the posterior wall was
completely gangrenous and sphacelated in the portion corresponding with the
symphysis of the pubis; the cellular tissue surrounding the anterior part of the
pelvis was infiltrated, and the divided bones were altered in their colour as in
necrosis; the section of the bone was clearly made on the right side, but on the
left the bone seemed rather fractured, and broken into scales. The symphysis
of the pubis was not divided, but the bone had been cut a little to the right
side. The peritoneum and abdominal viscera were perfectly healthy. The
uterus, which was contracted, was healthy on its external surface, but internal-
ly livid; the sacro-iliac symphysis had not been injured.
42. CsBsarean Operation. — A case of this was communicated to Dr. Wise, by
Dr. Leotard of Chandernagore, who assisted Dr. Tasse at the operation. The
patient, aged twenty years, had a deformity of the pelvis, and after being in la-
bour for four days, submitted to the Csesarean operation, which was performed
in the usual manner, and the dead child and placenta were removed; a bandage
was then applied round the body, and the wound was left without any dressing
for several hours, after which the edges of the incision were secured by the in-
terrupted suture and adhesive plaster. The wound was healed in forty days. — ■
Transactions of the Medical and Physical Society of Calcutta, Vol. VI.
43. The Advantages of Turning the Foetus hy the Head rather than by the
Feet. — Up to the end of the 16th century, the only mode of turning ever prac-
tised was by bringing down the head first; and we find this conduct recommend-
ed, not only in such cases as are admitted at the present day to require arti-
ficial delivery, but even in common pelvic and feet presentations. Soon after
the above-mentioned date, turning by the feet was first proposed, but it was not
until the commencement of the 18th century that the practice was generally
followed. One of the professors of the School of Strasburg resisted this inno>
vation, strongly maintaining the superiority of the old regime; and his advice
was approved of by many of the German practitioners. To justify this preference
it was asserted that when the head presented first, the compression caused by
the OS uteri is not sufficient to injure the encephalic contents, and moreover,
the communicant circulation between m.other and child remains unobstruct-
ed; whereas in presentations of the lower extremities, the thoracic and abdo-
minal viscera are exposed to a dangerous compression, and the fluids are driven
back upon the head, thus causing frequently a fatal cerebral congestion. In
confirmation of the truth of this statement, we are told that only one child in
twenty delivered by the head is still-born; whereas, the proportion is one to five
in feet presentations. In conclusion, it is alleged that whenever the foetus is
moveable within the uterus, it is quite as easy to effect the turning by the head
as by the feet.
M. Dubois dissented from the above arguments. He contended that the des-
cribed dangers of any compression on the abdomen and thorax were most un-
necessarily exaggerated, and instanced two cases wherein the shoulder pre-
sented along with the head, and yet the children were dehvered without any
contusion of the thoracic and of the abdominal viscera.
The dread too of theretropulsion of the blood upon the head was an offspring
of fancy rather than a result of experience, he did not agree with them in their
Ii belief that the os uteri exercised such a constrictive pressure as was alleged;
\ the parts of the foetus which have already escaped from the uterus are subject-
I ed to a less degree of pressure than those still contained within its cavity; and
" hence we can readily explain why the blood should be driven to and accumu-
lated in the former. Do we not observe that when an arm is born first, the
member frequently becomes much swollen? now this swelling arises from the
pressure being less upon the arm than upon the rest of the body. True it may
be, that in many children who die after feet presentation, visceral congestions
arQ not unfrequently discovered; but the cause of these is the compression of
262 QUARTERLY PERISCOPE.
the umbilical cord, and not the retropulsion of the fluids which M. Flamant
believed to take place.
The compression of the cord is a necessary danger attending" all births by the
feet, and indeed it constitutes a very serious objection to the process of turning;
the child is very often asphyxiated, and in such a case we find upon dissection the
same phenomena which are observed after drowning or hanging, viz. an apo-
plectic plethora within the head, great congestion in the veins of the cerebrum
and other viscera.
The calculations which have been adduced to prove the greater safety of
turning by the head than by the feet, are not strictly correct, as will appear from
the following statement of M. Dubois.
In all such calculations, to ascertain the comparative mortality of the differ-
ent modes of delivery, we must be careful to exclude from our tables all cases
wherein the child has died before actual accouchement has commenced; or
wherein the labour has been premature, and the child may be therefore not well
capable of independent life. Now the new tables which have been recently
formed at the Maternite of Paris, on these principles, shew, that from the 1st
of June, 1829, to the 1st of June, 1833, 10724 children have been born at the
hospital; of these 10262 were born by the head, 391 by the lower extremity, 59
by the trunk, and — 30 by the face; of the 10262, 9867 were at the full period
of gestation, and 395 were not. The 9867 may be reduced to 9837, because,
in 30 of the cases the foetus was known to be dead before delivery com-
menced, and the 395 premature cases may be reduced to 278; for in 83 the
foetus had been dead for some time, and in 34 it was too imperfectly developed
for the maintenance of independent life.
Of the 9837 deliveries by the head at the full time, 191 were born dead; the
proportion is therefore one in 51 or 52; and of the 278 prematurely born, 48 were
born dead, or one in every 5 or 6. Of the 391 deliveries by the lower extremity
238 were at the full term, and 153 before the term; from the first number we
must deduct 7, who were dead before labour began; and out of the remaining
231, 21 were born dead; a proportion of one to eleven. From the 153 we must
deduct 63, in which the child had evidently died during pregnancy, and 30, in
which it was too young for independent life; and out of the remaining 60, 10
were born dead; or one in six. From these calculations it appears among other
results, that the foetus at the full period can endure the ^^ fatigues of accouche-
menf with much greater safety than when born at an earlier period, whether
they are delivered by the head or not. M. Dubois draws our attention to the
important difference in the results by the previous deduction of all the cases in
which the foetus either had been dead for some time before labour, or was in-
capable of life when delivered. Thus had we enumerated these cases among
the mortality in the 10262 head presentations, we should have had 386 deaths,
or one in 25; whereas we have fixed it above at one in 51: and in the 391 feet
presentations the deaths would have amounted to 134, or nearly one in two in-
stead of one in eleven. With regard to the comparative advantages in practice
of turning by the head, M. D. admits that in some cases the operation is not
only quite possible, [Mad. Lachapelle was wrong in denying this,] but also
abundantly easy. He has himself performed it twice when the shoulder pre-
sented; but the operation is much more difficult than that of turning by the feet,
and should the liquor amnii have copiously escaped, or should the uterus be
firmly contracted around the child, the manoeuvre is almost impracticable. In
the 59 trunk presentations, two were delivered by means of turning by the
head; in a third case the expulsion of a putrid foetus took place by the shoulder;
and in the remaining 56 the child was bi'ought down by the feet. Out of the
whole number 59, in 25 only did the child survive; but M. Dubois is of opinion
that a still smaller number would have been saved had turning by the head
been tried in all. — Med. Chlrurg. Rev. January^ 1834.
44. Luxation of the Pubis during Delivery. — A robust female, twenty-three
years of age, pregnant with her first child, had a very difficult labour, the child
Chemistry. 263
died during" delivery. The last pain was so violent that the woman was con-
vulsively raised from her bed. Nine days after her delivery, Dr. Rieke was
called to the patient, and foiind on examination a luxation of the pubis; the
symphysis was broken, and the left side carried half an inch at least behind the
rig-ht. The external genital parts and vagina, were much tumefied, neverthe-
less the urine and lochia flowed freely. I'he patient complained of pain in the
region of the symphysis, and she could not walk. The patient having been
placed on her back, Dr. Rieke applied his hands upon the crista ilea, and push-
ing backwards, endeavoured to separate them as far as possible, in order to
restore the pubis to its natural situation; but he could not apply this force long
in consequence of the violent pain it occasioned to the patient. Nevertheless,
after several trials, this succeeded on the second day, whilst the patient held
her legs flexed upon her thighs. From the moment that the luxation was re-
duced the patient could walk. To relieve the unsteady walking, and close the
articulation, the patient was directed to wear for some time a bandage similar
to a truss. On examination, it was found that the descending branches of the
pubis formed an acute angle which contracted the inferior straight. — Heidel-
berger Klinische Annahn^ B. vii. S. 3. 1831.
CHEMISTRY.
45. New Method of Preparing Medicinal Prussic Acid. — Richard Lamikg, Esq.
recommends the following formula for the preparation of medicinal prussic acid
by the extemporaneous decomposition of cyanuret of potassium: — Take of Cya-
nuret of potassium, 22 grains; Tartaric acid crystals, 50 grains; Distilled water,
6 fluid drachms; Rectified spirit, 3 fluid drachms; in a phial capable of contain-
ing eleven or twelve fluid drachms. Dissolve the tartaric acid in the water and
the spirit, previously mixed together, and suffered to become quite cold; then
add the cyanuret of potassium, and immediately close the phial with a sound
cork. After occasional agitation during ten minutes, secure the cork and set
the phial aside, for the supertartrate of potass to precipitate — when the clear
solution may be decanted for use.
The medicinal solution thus made, Mr. Laming states, is " always of the same
strength; nor is it an insignificant recommendation, its being much less hable
to spontaneous decomposition than the sorts made in any other way.
"There has been an impediment in the adoption of such a formula, in the
delicacy of the cyanuret of potassium; no plan heretofore having been disco-
vered for its formation in a state of purity. The few specimens of this salt which
I have been able to collect, have all exhibited a variety of hues, depending on
particular contaminations; and in some instances they were found to contain
large quantities of carbonic acid. The prussic acid made with them was usual-
ly, in consequence, of a deep yellow colour; but at times it was obtained green,
and brown, and blue.
" The accompanying cyanuret of potassium is pure, and I believe the first spe-
cimen ever obtained in a state of purity. By analysis I have found its composi-
tion to be —
Cyanogen - - 3.25 X 8 = 26
Potassium - - 5 x 8 = 40
8.25 66.0
and that of anhydrous prussic acid being
Cyanogen - - 3.25 X 8 =26
Hydrogen - - .125 X 8 = 1
3.375 27.0
" We have, of course, in every 66 grs. of cyanuret, an equivalent for 27 grains
of absolute acid; and this number being allotted, in the new formula, to 27
264
QUARTERLY PERISCOPE.
drachms of liquid, every 60 minims of the medicinal pnissic acid will contain
precisely one grain of the strong medicine. The relative strengths afforded by
the known formulas stand thus: —
Number of Grains of absolute Prussic
Acid in 60 Minims of Medicinal So-
lution.
Plan by
Formula by
Real.
Estimated.
Scheele.
Scheele.
H
8
Pharm. Dublin.
Pharm. Dublin.
lorli 1^
Gea Pessina.
Henri.
unknown.
20
Proust.
(both ascribed
Pharm. Gallica.
to Vauquelin.)
1 ©r about.
H
Vauquelin &
Gay Lussac.
Magendie.
7
7
Robiquet.
20
20
New Plan.
New Formula.
1
1
*' This table will explain the reason why one grain in a fluid drachm has been
adopted for the new formula: in the first place, it is about the strength which
experimentally results from the only process at present sanctioned by either of
the British Pharmacopoeias; it is also near to that of the medicinal acid usually
called Vauquelin's; and from Scheele's it differs by about half a grain, on that
side which will be a guarantee against a careless dispenser of prescriptions
doing mischief, should he mistake the newly-introduced medicine for his. In
addition to this, it has been thought to afford facilities for the correct estima-
tion of a dose." — Lond. Med. Gaz. Sept. 1833.
46. Test for Hydrocyanic Acid, and Method of appreciating the Quantity.—^
We are informed by Mr. JoH]?f T. Barky, that the nitrate of silver, in common
with other salts of that metal, is so extremely delicate a test of the presence of
hydrocyanic acid, that its detection is not difficult in a drop of water containing
far less than the ten thousandth part of a grain of that poisonous agent. For in-
stance, if one minim of the dilute medicinal solution be mixed with a pint of
water, its presence may be demonstrated in a single drop of the mixture. But
what is of more consequence is, that although the mixture be contaminated
with various organic substances, such as those contained in articles of diet,
milk, coffee, tea, porter, wine and soups, so far as is yet known the test retains
its sensibility unimpaired. Mr. Barry, however, thinks that this extreme sen-
sibility, while it renders the evidence of the silver test conclusive as to the ab-
sence of prussic acid, will be of more limited service in establishing 'As presence^
for, without adverting to the possibility of other volatile substances being here-
after discovered to have a similar effect on solution of silver, it is to be borne in
mind that this reagent indicates the existence of prussic acid in some esculent
substances where it had previously been found, as well as in some new ones.
Upon this branch of the subject medical jurists will probably think it right to
collect information.
The application of the solution of silver is simple. The suspected fluid is to
be acidulated by the addition of acetic acid, but so as to redden litmus paper
Chemistry. 265
m only the dlghtest degree. If excess of acid be already present, it is to be not
^mYe neutralized by carbonate of soda. These precautions are adopted to re-
tard the interference of ammonia or muriatic acid. Two or three drops, quite
cold, are then put into a Avatch glass, and immediately covered by a plate of
glass, whose under surface, to the breadth of a pea, is moistened with solution
of nitrate of silver, formed by dissolving- one grain lunar caustic in 100 grains
distilled water:— •
If the inverted drop of silver solution retain its transparency unaltered, the
absence of prussic acid is established; for had it been present, the silver solution
would in a few rnoments have become clouded by the formation of a white pre-
cipitate, an effect which, indeed, is almost instantaneous when the prussic acid
is not excessively diluted. If, on the other hand, the precipitate appear, the
conclusion must not be drawn, that it is cyanuret of silver, until identified as
such by two properties: — first, its speedy re-solubility, as denoted by the
clouded drop becoming again clear, when placed over a vessel of caustic ammo-
nia, in which respect it differs from the silver compounds of iodine and bro-
raime:— and secondly, in retaining unchanged its pure white colour after expo-
sure a few minutes to the sun's rays, or for a longer time to day-light. As this
property essentially distinguishes it from the compound of silver with chlorine,
it is important to establish it by a separate experiment upon a somewhat larger
portion of the precipitate, which sliould be obtained by candle-light, by suc-
cessively placing the inverted drop of nitrate of silver over renewed portions of
the liquid in a saucer, as soon as the precipitate separates into distinct curd-
like particles, it is ready for exposure to the solar rays.
Another property which distinguishes the cyanide, (or cyanuret,) of silver
from the chloride, is, that upon being ignited in an open short glass tube, the
cyanogen burns with a flame of the usual colour, leaving the metal pure, if suf-
ficiently heated, — a quality the more valuable as it furnishes an index to the
proportion of prussic acid it represents, which upon ordinary occasions may be
estimated as equal to one-fourth the weight of residual silvero
When, acting upon this principle, it is desirable to ascertain the entire quan-
tity of prussic acid, it is to be obtained by slowly distilling over, in nearly filled
close vessels, about an eighth of the acidulated mixture under examination; rec-
tifying it; reacidulating by acetic acid; precipitating by slight excess of nitrate
silver; washing with distilled water, only so long as the washings affect litmus
paper; drying at 212°; weighing: — and lastly, igniting and re-weighing.
The medicinal solution above referred to, (as to be diluted for experiment in
the proportion of one drop to the pint of water,) contains, in round numbers,
nearly a sixteenth of its own weight of anhydrous prussic acid, or rather less
than four grains in the drachm, being the article, (commonly designated ** of
Scheele's strength,") as manufactured by some respectable houses in London.
We understand that Messrs. William Allen and Co., by means of silver as a
reagent, have uniformly concentrated it to this degree since the year 1820, when
Mr. Barry introduced the use of that metal to determine and regulate its pro-
portion of absolute prussic acid by the formation of cyanuret of silver. The
method being one which admits of extreme precision, will deserve the atten-
tion of the College of Physicians, if prussic acid be inserted in the next Phar-
macopoeia. It is to be recollected that this preparation, like those of alcohol or
aether, is subject to variation, notwithstanding any superiority of formula, or
care on the part of the operator. Hence the necessity of means for assaying
the final product and for reducing it to a uniform standard. With regard to the
employment of cyanuret of potassium for the occasional formation of hydro-
cyanic acid, it is a question which at least deserves very serious consideration.
Its disposition to absorb atmospheric moisture, and always to become more or
less converted into carbonate, while its cyanogen, (united to hydrogen,) to an
uncertain extent is dissipated, especially when this beautiful salt is much disin-
tegrated, constitute formidable difficulties. But a still greater objection will
present itself at the counters of apothecaries and chemists where medicines are
No. XXVIL— Maj, 1834. 23
266 QUARTERLY PERISCOPE.
made up, from the possibility of this intensely poisonous salt being sometimes
mistaken for other substances, in the frequent extemporaneous production of
prussic acid. — The London and Edinburgh Philos. Mag. &c. February, 1834.
47. On Cusparia from Angustura Bark. — M. Saiadiw obtains cusparia from
angustura bark by the following- process: Digest seven parts of the bark in 20
parts of alcohol, of sp. gr. 0.795, without heat: let the spirit evaporate gra-
dually at a very low temperature. After some days have elapsed, there will be
observed very slight mammellated crystalline appearances, in a magma of co-
louring and extractive matter, &c. &c., and also deposited as acetates upon the
upper part of the sides of the vessel. When carefully separated from the liquor,
pressed and freed by a small quantity of water from the greater part of the
foreign substances mixed with it, the crystalline form appears regular, though
not very distinct.
By fresh treatment with alcohol, of sp. gr. 0.8349, and successive agitation
with a little hydrate of lead freshly precipitated and aether, it separates, though
with difficulty, from the fatty and colouring matters witli which it is mixed;
and it presents, even after some hours' exposure to a freezing mixture, acidu-
lous crystals, united in concentric groups, the greater part of which are tetra-
hedrons and various modifications of this form.
These crystals dissolve in alcohol, and more rapidly when moist than after
drying; the solution is bitter and slightly acrid: it does not act either as an acid
or as a base. It dissolves readily in acids, and forms during their concentration,
especially in acetic and muriatic acids, a white flaky deposit, which retains acid
strongly even after a number of washings: it appears, however, to be merely a
hydrate of cusparia.
It is insoluble in the volatile oils and xther, but dissolves in small quantity in
water, according to its temperature: 1000 parts of water, at 55° Fahr., dissolve
5.45 parts; at 212°, 11.04 parts. Alcohol of 0.8356 at 60° dissolves 37-lOOdths
of its weight.
Nitric and fluoric acid at common temperatures renders cusparia yellowish
green; sulphuric acid turns it reddish brown: neither iodic nor muriatic acid
produces any visible alteration: the salts and the protoxides of iron and tin, the
acetate and subacetate of lead do not precipitate its solutions. These characters
are sufficient to distinguish it from brucia; like brucia and salicine, however, it
possesses the property of being reddened by pernitrate of mercury. — This test
will serve to detect the smallest admixture of salicine with sulphate of quina,
even l-743dth.
Tincture of galls precipitates cusparia abundantly both from water and alco-
hol: the alkalies dissolve it partially without altering it. Chlorine, iodine and
bromine in the gaseous state colour it; the first of a straw yellow, and the two
last brown. In the first case, the cusparia becomes more soluble in the state of
a peculiar acid; the washings contained only traces of chlorine.
When heated to 130° Fahr. and gradually higher, cusparia first melts, and
then loses 23.09 per cent, of its weight. It does not appear to suflTer any alter-
ation until it is heated to about 270° Fahr. ; it then burns, without leaving any
appreciable residue, and without subliming or phosphorescing: its vapour at a
lower degree does not indicate azote as one of its elements; and by this it is also
distinguished from brucia. The only circumstances which require notice in
the angustura bark are, that it contains rather a large quantity of pectine and
no copper.
Cusparia is not poisonous, even in large doses; its properties appear to ap-
proach those of quina, gentianine and salicine. When the watery and acid ex-
tract of the bark is treated with animal charcoal, alcohol, &c., there may be
obtained by crystallization about 13-lOOOdths of the weight of the bark em-
ployed.— ibid, et Journ, de Chim. MM. July, 1833.
( 267 )
AMERICAN INTELLIGENCE.
Case of Adhesion of the Placenta to the Fundus of the Uterus^ successfully treat-
ed by Ergot. By Edwahd Worrell, M. D. Assistant Surg-eon U. S- Army.
[CoQimunicated in a letter to the Editor.] — Sir — In your very valuable Journal
I find many cases recorded of the effects of the Secale cornutum, or ergot, and
as the following- is one of rare occurrence and some practical importance, I take
the liberty of forwarding it for your disposal.
Case. — I was called to visit a black girl who, I was informed, was in labour,
but on arriving at the house was told " she had been delivered of her child
three days before, but that the after-birth was still retained." 1 found her with a
countenance expressing much anxiety; severe pain in the region of the uterus;
a hot, dry skin; and her pulse about 120 in a minute and very small. On raising
the bed-clothes to introduce my hand for examination, there escaped the most
disgusting stench I ever encountered. 1 then introduced my finger into the va-
gina, upon which she sprung to the head of the bed, exclaiming, *'0h, you
will kill me." I immediately withdrew my hand, and asked what was the mat-
ter? She then told me "that the nursehadfelther so much that she could not bear
to be touched." I explained the necessity which existed for an examination, and
that it was impossible for me to render her any assistance unless she submitted.
She then told me she would bear it. I again introduced my finger, and carried
it to the OS uteri along the cord, which I found so firmly contracted that I could
scarcely introduce the end of my finger, and its edges quite firm, and yielding
none to the pressure made upon it. I then held the finger of the right hand at
the OS uteri, and drew gently, with the left hand, the umbilical cord in order to
ascertain where the adhesion existed by the course of the cord. This I found to
be at the fundus, and that very firmly. The case to me was a novel one. I
never had seen or read of a case having occurred, and the only light thrown
upon the subject is a paragraph in Dewees' System of Midwifery, where he
says that he has never seen a case of adhesion of the placenta to the fundus of
the uterus, and at the same time a contraction of the os uteri, but that he would
suppose the Secale cornutum might be advantageously used. We know the
powerful effects of this remedy on the fibres of the uterus — we know that it
produces strong contractions — then the question arises, will the contraction of
the longitudinal fibres overcome the force of the circular? if so, the os uteri
must dilate — I believed it would, and consequently gave fifteen grains of the
ergot as a dose. Its effects were powerful, and continued some time, but with-
out producing any other effect. In half an hour I repeated the dose with the
same result as the first, except that the contractions of the uterus were stronger.
I repeated the third, fourth, and fifth time, with an interval of half an hour be-
tween each dose. Imoiediately after giving the fifth dose, making in all seventy-
five grains, I had the pleasure to find the os uteri open, the adhesion give
way, and the placenta delivered. The girl did well with the exception of a
mild phlegmasia dolens, which yielded to simple remedies.
Fort Howard, Green Bay, Michigan Territory, December 28/^, 1833.
On the Climate of Florida. By H. Perrike, M. D.— I have just re-
ceived the 25th No. of your Journal for November, 1833. Among the
subjects most interesting to me, is the article under *' American Intelli-
gence," headed "St. Augustine, East Florida, as a Kesort for Invalids."
Dr. Bell has rendered a great service to truth and humanity in showing the va-
riability of its climate. It is true, that it is not so variable as the south of France
or Italy; that it is preferable to that of Charleston or New Orleans, but it does
not still approximate to that of the torrid zone. In Campeche the lowest tem-
perature in seven years has been 62°, and the highest 98°. Recollect that one
occurred on the coldest night, or rather break of day in the coldest winter, and
that the other was noted at the hottest, X o'clock in the afternoon of the hottest
268 QUARTERLY PERISCOPE.
summer. The upper part of Florida, or that within the range of the miscalled
temperate, but really variable zone, has been politically divided into Eastern,
Middle, and Western Florida. By far the most important portion of that Penin-
sula is unsurveyed, unsold, unpopulated, and consequently unknown. I am
willing- to let the eastern and middle sections of the upper division extend down
to 28°, but all below I claim the right to baptise under the name of Southern
or Tropical Florida. In my address 1o the " Intelligent Friends of the Union,"
pubHshed in October, 1832, 1 first called the attention of the pubhc to the fact,
that the climate of the tropics extends beyond its astronomical boundary seve-
ral degrees north into this most interesting portion of our territory. Nature
does not confine herself within the artificial lines of astronomers. It has long
been known that degrees of latitude do not indicate degrees of temperature,
and that still less dependence can be placed upon them in the western than in
the eastern hemisphere. In America the temperate and the torrid zone of the
books encroach upon each other, and an intermediate division might more na-
turally be traced under the title of the tropicoid zone. Why the term temper-
ate should continue to be applied to the region of variable chmates, is more
easily explained than excused. It is however certain, that the epithet is more
applicable to the uniform temperature of those districts included under the
names of hot or tropical climates, or still more erroneously of the torrid zone.
The facts are, that extreme heat is greater at the pole than at the equator, and
that it does not depend on the distance or position of the sun, but on the time
it remains above the horizon. It is nearer to us in winter than in summer; ap-
proximates to a perpendicular position more at noon than in the hotter hours
afterwards; raises still nearer to our zenith in the pleasant month of June than
in our scorching July or August, and then elevates the thermometer higher in
Boston than in New Orleans. In using the possessive our, I of course speak
of our broad and happy home, the United States. Were the surface of the
globe a uniform level of land or water, the rule would be universal, that heat
and cold exactly correspond with light and darknesb. When the length of the
day and of the night were equal, so would be the heat of the one and the cold
of the other over all the earth. The heat accumulated during twelve hours of
light, would be lost during twelve hours of darkness. Under actual formation
the law is general, that the nearer we approach to the poles, the hotter is the
hottest day of summer, and the colder is the coldest day of winter, and the
nearer to the equator, vice versa. But strike out every thing theoretical in the
foregoing lines, and let us return to the facts relative to the climate of the
Peninsula of Florida. It will no doubt appear strange, that within a hundred
and fifty miles of St. Augustine, we will not merely find a much greater unifor-
mity of temperature, but also all the phenomena of a tropical climate; yet it is
not less strange than true.
The other general characteristics of the tropics are a warm dry winter, a wet
refreshing summer, a cooling breeze from the sea by day, a cooling breeze from
tlie land by night, and a westwardly current of the atmosphere, as well as of the
waters commonly called the trade wind. The great equatorial current of rota-
tion to the west, is in the Newtonian philosophy, attributed to solar attraction,
but like the tides, would doubtless occur if both sun and moon were stricken
from the universe. Without going beyond the earth, its combined diurnal and
annual motions are sufficient to account for the movements of the liquid and
aerial fluids upon its surface: whatever be the theory adopted, we should
a priori, infer that the westward winds and waves should be both stronger and
steadier in proportion to their proximity to the equator. But the equatorial
current of water, which, in the wide Pacific Ocean acquired sufficient strength
to cut off' New Holland from Asia, required so little force in its voyage across
the Indian Ocean, that unable to cross tropical Africa, or even to wind round
its northern border through the Red Sea, it was content to wear its way round
southern Africa, scooping out its eastern shores up to the equatorial belt of the
Atlantic Ocean. Reaccumulating strength in its natural route, it made a des-
perate attempt to force a passage through equatorial America, but became so
American Intelligence. 269
exhausted after reaching- the Isthmus of Panama, that It suffered itself to be re-
flected northward between the AVest India Islands, which it had separated from
the main land, and makes its hot appearance on our coasts under the name of
the Gulf Stream, cooling-, weakening-, and widening on its sultry journey back
to the eastern hemisphere. The equatorial current of air is as little conforma-
ble to the rules of general philosophy. It should be very strong and very steady
at the equator, but it is neither strong nor steady nor directly westward there,
nor within several degrees either north or south of that line. On the contrary,
the wind is more strongly and steadily from the east in the latitudes of tro-
pical Florida than within any portion of the torrid zone. For a confirmation of
these facts, you can refer to a paper by Basil Hall, published in the American
Almanac or Repository of Useful Knowledge for 1832. However incorrect
may be the observations of this naval captain on land, we have no reason to
question his testimony relative to the winds, which have carried him over the
sea in every part of the world. The sea and land breeze of the tropics are also
liable to accidents not foreseen in the books. In some districts, and at some
seasons, the sea breeze will last all night, and the land breeze will endure all
day. According to the position of the coast, they may combine with, be modi-
fied by, or entirely opposed to the trade wind; there may be no sea nor land
breeze at all. The width or the elevation of the land, of course, influence
these phenomena. In Yucatan the sea breeze rarely extends thirty miles in the
interior. In the hottest dry months, from February to June, the land breeze
becomes what is here called warm south-easters, and endures sixteen, eighteen,
or twenty-four hours; but the sea breeze compensates in force what it has lost
in time. On the eastern coast the trade wind aids the sea and opposes the land
wind, but as the peninsula is so very broad, it is cooled sufficiently in the night
to overcome the impulse of the trade. Were there mountains in the centre of
the peninsula, they would not merely oppose a mechanical resistance to the
westwardly wind, but would vary still more the temperature of the atmosphere.
Returning to tropical Florida, it will be perceived that it enjoys a combina-
tion of advantages for uniformity of temperature that can rarely be equalled in
the torrid zone itself. Its surface is narrow. It cannot hence accumulate much
heat by night, or lose much heat by day compared with the temperature of the
adjoining oceans. Its surface is level, and cannot hence experience those va-
riations of temperature which are produced by hills or mountains.
It stretches to the south, and hence the trade wind passes at right angles
across it. Even its inclination to the east is advantageous, a north wind will
have to pass over a portion of the sea before touching it. A complete north
west wind must also cross a part of the Mexican sea to reach the south western
extremity of the peninsula. But above all it has a peculiar regulator of its tem-
perature, hugging its eastern shore, and inchning a little to the west of north.
The Gulf Stream freighted with the heat of the torrid zone rushes out between
Yucatan and Cuba, runs to the east between Cuba and Florida, and sweeps round
to the north between Florida and the Bahamas at the rate of five miles an hour,
and with a steady temperature of eighty-five degrees. The steady trade wind
crosses this steady hot river, imbibes its steady temperature, and steadily dis-
tributes it over the narrow and level surface of tropical Florida. I would not,
however, have you infer, that southern Florida is a mere marsh, or a dead level,
ready to be overflown by the ocean. On the contrary, the only marshes level
it can have, must be the summit level of the whole peninsula. The passage of
the Gulf Stream to the north is alone an evidence of the superior elevation of
the southern extremity, which is placed beyond a doubt by the river St. John's,
taking its rise there, and after meandering several hundred miles to the north,
finding an outlet into the sea beyond St. Augustine. The streams then which
rise in the same summit level, and discharge directly in the western southern or
eastern shore, must have a rapid descent in their channels favourable for me-
chanical power, or what is still more important in the dry warm winter of tro-
pical climates for irrigation. Be that as it may, we have testimony of the healthi-
ness of Cape Florida in its most unequivocal form. The family of J. Dubose,
23*
270 QUARTERLY PERISCOPE.
consisting of eleven whites, and several negroes, has not had a case of sickness
during the last seven years. The tenderest and most productive vegetables of
the tropics are flourishing under his care, viz. the benana plant, and the cocoa
palm, which are universally admitted to be the greatest blessings of God to man.
The harbour at the cape is the first below St. Augustine, and is easily accessible,
and a voyage to and from the northern states can be made with less risk and in
less time. Admitting then that in southern Florida we have combined a warm
dry winter, a cool refreshing summer, a breeze from the sea by day, and from
the land by night, a perpetual westward wind, and uniformity of temperature
even superior to the West Indies, humanity requires that it should be made an
available resort for invalids as soon as possible. Our mineral springs are in ge-
neral surrounded with all the conveniences and comforts of elegant life, al-
t?iough it was more costly and troublesome to collect them there than it wall be
at Cape Florida. An association might readily be formed with a capital of a
hundred thousand dollars, which would furnish the buildings, gardens, and
other conveniences requisite for the most squeamish visitor, and keep a packet
running every month with passengers and effects to and from the north. The
most luxurious accommodations could be profitably afforded at half the price
paid in Havana. There is no necessity for detailing the disadvantages attend-
ing a sick American on the island of Cuba, which is the next nearest tropical
territory. A part from the difference in language, laws, and customs, it is suffi-
cient to name the horrible prejudice against consumptive patients, as the people
are firmly persuaded that every disease with a cough is contagious. In Cam-
peche so strong is the prejudice that the clothes of the patient is burnt, and
the walls and floors of the rooms cleansed and white-washed.
Were it not for the disagreeable peculiarities of all Spanish countries I should
long since have recommended Campeche as a winter resort to our consumptive
patients. The cities inhabited by that race alone, are entirely divested of
houses for accommodation to strangers. With a population of at least 20,000 in-
habitants, there is not a single establishment entitled to the name of hotel, and
the only two apologies for transient visitors are miserable dirty places, not fit
for a sailor's boarding house in the north, one of which is kept by a French
negro woman, and the other by an Italian sailor. Luckily the fine temperature
of the climate enables one to dispense with bed and bedding, and a hammock
slung up under a shed or any shelter from the dew is sufficient to pass the night.
I am now sitting in one at 3 A. M. with the thermometer at 74°, which has not
varied three degrees in the last three days and nights, while I observe in Dr.
Bell's register that at St. Augustine during the same period there was a differ-
ence of 22° in the temperature of the days alone. With my self registering
thermometer I have commenced noting the extremes of the present month of
February, which I hope will arrive in time for your May No.
Consulate of the United States of America^ Campeche^ February 3d, 1834.
Sequel of Dr. Hulse's Case of Ununited Fracture of the Os Humeri, treated by
the Injection of a Stimulating Fluid into the Wound. — Dr. Hulse, in a letter,
dated U. S. Hospital, Pensacola, March 17th, 1834, informs us that Isaac Hard-
ing, the seaman, whose case is related in our last Number, p. 374, has been
discharged from Hospital, and has returned to his duty.
Remarkable Location of Parturient Pains. By Chandlek RoBBiifs, M. D. — The
lady who was the subject of this case usually enjoys good health. With the ex-
ception of occasional head-aches, she has seldom been ill, except at the periods
of her confinement. She has had three children, at the birth of all which I
have assisted her. The eldest is about seven years old, and the youngest about
as many months. Her labours have been severe, and lasted from six to ten hours;
but in no period of either have the pains been referred to the back or the groin,
or the uterine region. They have all been confined to the muscle around, and
particularly in front of the/emi//-. They have been most severe about midway
between the upper and lower extremity of this bone. Here she has solicited
pressure, and here, at the commencement of each pain, her own hand has been
American Intelligence, 271
involuntarily placed. In every other character but their location^ the pains have
been such as we always find them; but to this location they have been confined —
no sensation of pain having been at any time referred to the vicinity of the uterus.
This case may stand on record as undeniable. The lady is altogether above
deception or pretence. Her moral sense is of the highest order; and being ac-
customed to the most refined society she would shrink from, rather than court,
any notoriety on a subject of this nature.
It may not be amiss to add that the after-pains have also been confined to the
same region. Dr. Dewees remarks in an article on after-pains, in that excellent
compend. Dr. Hays's Cyclopedia, that he once knev/ after-pains located in the
knee; and once, in the jaw.— ^os/o?! Med. and Surg. Journ. March lOthj 1834.
Notes of a case of Fistulous opening of the Stomachy successfully treated hy
Dr. J. H. Cook. — Some time in the month of February, 1832, Dr. Bardwell and
myself were called to visit the widow D., aged thirty -nine years. We found
her, as near as may be, in the following condition: A fistulous opening, imme-
diately by the side of the umbilicus, into which a buck-shot might have been
readily passed; on removing the bandage, a gill of bile was suddenly discharged?
after which, a small quantity of a different (the gastric ?) fluid, came slowly
away. These discharges were attended with great pain, on account of their
acrid quality. The whole surface of the abdomen was excoriated, inflamed and
intolerably painful. We introduced a flexible catheter, its whole length, thirteen
inches, before meeting with any resistance, when the extremity suddenly met
with an obstacle. By pushing it against the resisting body, or even by slightly
agitating the instrument, strong efforts to vomit were produced.
Withdrawing the catheter, we desired her to drink a glass of water; she did
so, and in twenty seconds, the whole was discharged through the fistula, as we
ascertained, by measuring it. The direction of the fistula was upward, and
slightly inclining backwards, with about the same inclination to the right side.
We came to the conclusion, that the opening within, was at, or about, the
pyloric orifice of the stomach; and that the catheter entered the stomach, and
pressed against its cardial portion. The patient even felt it there, and applied
her hand externally over that part.
Treatment.— -T2i\im^ a large beef's bladder, v/e cut it open, longitudinailyj
spread it well with adhesive plaster, and after washing the inflamed surface^
and dressing it with basiiicon spread on fine linen, we applied the bladder over
the abdomen, and made an opening over the fistula, through which the matter
might escape. We then applied a bandage and compress, and directed that it
should be reapplied immediately after each discharge. We advised mucilaginous
drinks, and a diet of rye-mush and molasses, and nourishing enemata. The
patient was much emaciated for want of proper nourishment, as every thing
passed off" undigested through the fistula. No evacuation had taken place in
the natural way, for ten days previous to our visit. The external irritation of
the abdomen soon healed, and the bladder was then applied to the skin as a
protection, and continued there with the happiest effect. The bandage was
gradually tightened, and a compress of a cylindrical form was laid over the
course of the fistvilous canal. By these means our patient regularly, but slowly
recovered. In a few days the alvine evacuations were restored to their natural
outlet, and the discharges from the fistula began to decrease. In thirty days
the opening was closed, and the fistula apparently obliterated. Several months
have elapsed since that event, and she continues in excellent health.
All we could collect from her as to the history of her case, was this: Six
months before, in one of the south-east counties of this State, she was attacked
with constipation and violent pain at the pit of the stomach, which resisted
every remedy, till the 19th day, when the fistula showed itself. — Western Journ.
of Med. and Phys. Sciences^ January, 1834.
Observations on the Pathology of Fever. By Joiisr P. Harrisois', M. D. — Were we
not well acquainted with the author of these observations, who we know to be an
ardent votary of his profession, though rather distinguished for brilliancy of
272 QUARTERLY PERISCOPE.
imagination, than for talents for patient and careful investigation, we should
hardly have suspected him of having- indited this extraordinary rapsody in sober
earnestness. The want of precision and accuracy which usually distinguish the
attacks upon the physiological doctrine eminently characterize the present one.
Dr. Harrison makes sad confusion in the doctrines of the day. He appears to
suppose that all the practitioners in France are Broussaisans! What will the
Pinelians, the Pathological Anatomists, the Eclectics, &c. say to this? He as-
sumes that according to the physiological doctrine, *' fever is nothing more than
gastro-enterite!" He charges the disciples of this doctrine with ''having
drawn from the magazine of fancy for a theory of fever,'' and then triumphantly
asks, "will the corruscations of a fervid imagination eclipse the sober splendour
and guiding radiance of a just experience?" (!) He informs us that "the disci-
ples of Broussais in France, differ on the exact site of the inflammation in the
intestinal tube. Louis, in his work entitled Recherches Anatomiques, Patho-
logiques et Therapeutiques sur la maladie connue sous le nom gastro-enterite,
&.C. says, that in every case of fever, the elliptical plates of the bowels are the
seat of lesion. ' De toutes ces lesions une seule etant constante, ayant lieu
chez tous les sujets, je veux parler de I'alteration de plaques elliptiques de
I'intestin grele, &c.'* Others assert, that the glands of Peyer and Brunner are
the seat of the lesion, whilst some state that fever is altogether dependent on
follicular ulceration." If M. Louis will not admit the accuracy of the anatomi-
cal distinctions pointed out in this quotation, he will at least be somewhat sur-
prised at being classed among the disciples of Broussais. Had Dr. Harrison
taken the trouble to ascertain with precision, what are the glands of Peyer and
Brunner, the elliptical plates of Louis, the mucous follicles of the intestines, he
might have been led to suspect that this argument, which he appears to think
is destined to give the coup de grace to the physiological doctrine, is not very
overwhelming. Indeed, it will be somewhat ludicrous if it should turn out as
we shrewdly suspect it may, that the eUiptical plates of Louis consist of the
glands of Peyer in a state of engorgement and ulceration, and that Peyer's
glands are nothing more than mucous follicles, the follicules agminees of the
French pathologists. Were Dr. Harrison an obscure practitioner, or had his ob-
servations been issued as an ephemeral pamphlet, and thus likely to have but a
limited circulation, we should have passed them over unnoticed, as we have
raany other similar attacks upon the physiological doctrine. But Dr. Harrison
is one of the medical magnates of the west^ his paper has had currency given
to it, by its insertion in one of the most respectable journals in this country,
(the Baltimore Medical and Surgical Journal, No. 2,) and we should therefore
be recreant to our trust were we to allow it to pass without comment, calcu-
lated as we conceive it to be, neither to inculcate correct information at home,
nor elevate the character of the profession abroad.
Professor DungUson's Address delivered to the Graduates of Medicine at the Com-
mencementy March 19th, 1834. — This is an interesting exposition and criticism of
the opinion of Lamarck, who maintains, that the habits of an animal are not de-
pendent upon its organization; but on the contrary, its habits, mode of life, and
those of its ancestors, have, in the succession of ages, determined the form of
its body, the number and condition of its organs, and the functions and faculties
it enjoys. This able address has been published by the graduates and students.
The Value of a great Medical Reputaiiorif with Suggestions for its Attainment;
a Lecture^ Introductory to the Summer Course of the Medical Institute. By J. K.
Mitchell, M. D. Lecturer on Chemistry. An interesting subject well treated.
University of Pennsylvania. — The number of students in this institution dur-
ing the session 1833-4, was 860; of which, 431 were medical students.
Medical Department of the University of Maryland. — The number of students*
exclusive of graduates of other schools and officers of the army and navy, was 143.
* Paris, 1829, p. 449, torn. 1.
QUARTERLY
MEDICAL, ADVERTISER.
IN consequence of the extended circulation of the Americais- Jouknal of
THE Medical Sciekces, the Proprietors intend, in comphance with the wishes
of many of their Friends, to affix to each No. a Sheet of Advertisements. All
Booksellers, Medical Gentlemen, and others desirous of taking- advantage of
this mode of announcement, will please address their Advertisements to
Caret, Lea & Beatstchard, Philadelphia, by the 10th day of the month pre-
ceding- that of the publication of the Journal, viz. on 10th July, 10th Octobers
10th January, and 10th April.
For one page Six dollars.
Half a page or less Three dollars.
Pkiladelphiaf January 20, 1830.
UNIVERSITY OF PENNSYLVANIA,
M a Commencement held publicly in the Musical Fund Hall, Locust street, March
27th, 1834, the Degree of Doctor of Medicine was conferred upon the following
gentlemen: —
NAMES.
Armstrong, Ralph C.
Allen, Samuel A.
Abbott, Thomas H.
Anderson, Richard
Alexander, John Thomas
Arrott, Colin
Armistead, William A.
Bouchelle, Robert M.
Bond, John W.
Booker, Shields
Binford, Henry A.
Baldwin, Isaac H.
Beekman, William F.
Balfour, William T.
Bellamy, Samuel C.
Boyd, John
Boyer, Conrad R.
Bower, William H.
Bryan, James
Buchanan, Archibald H.
Baugh, John M.
Crump, George
Camm, Edward
Chambers, Benjamin F,
Colhoun, John B.
Coleman, Richard
Chewning, Albert G.
Gotten, John A.
Conover, William J.
Christian, Andrew H.
Cross, Richard
Coate, Daniel
RESIUENCE.
Georgia,
Virginia,
S. Carolina,
Virginia,
Louisiana,
Philadelphia,
N. Carolina,
N. Carolina,
N. Carolina,
S. Carolina,
Alabama,
Virginia,
New York,
Virginia,
N. Carolina,
Pennsylvania,
Philadelphia,
Virginia,
Philadelphia,
Tennessee,
Virginia,
Virginia,
Virginia,
S. Carolina,
Philadelphia,
N. Carolina,
Virginia,
N. Carolina,
New Jersey,
Virginia,
Virginia,
Upper Canada,
ESSAY.
Fever and its Treatment.
Scarlatina.
Bilious Worm Fever.
Gonorrhoea.
Capillary Circulation.
Injuries of Head.
Intermittent Fever.
Pneumonia.
Hepatitis.
Digestion.
Remittent Fever.
Organic Force.
Strictures of Urethra.
Strictures of Urethra,
Scarlatina.
Hydrothorax.
Digitalis Purpurea.
Coxalgia.
Epidemics.
Mental Derangement.
Scarlatina.
Hydrops.
Intermittent Fever.
Vermes.
Ulceration.
Acute Hepatitis,
Acute Hepatitis.
Catamenia.
Fever.
Scarlatina.
Conception.
Nephritis.
274
Quarterly Medical Advertiser.
Dossey, Alonzo B. C.
Drake, Joseph A.
Denig-, Georg'e W.
Dalaney, William J.
Davis, William
Ealy, Elijah
Ely, Henry P.
Egbert, Daniel
Finley, Clement A.
Fowler, Newton
Frayser, John R.
Franklin, James E.
Germany, William
Greg-g-, David R.
Graham, Calvin
Grattan, John
Gordon, Benjamin W.
Gilpin, J. Bernard Jr.
Gilliam, John R.
Gaskell, Isaac P.
Godon, Victor L.
Harrison, Thomas A.
Hambleton, Alexander
Harvie, John B.
Hite, Walker M.
Hull, Peter K.
Hoxton, William W.
Hicks, Benjamin J.
Hollingsworth, J. Yellott
Huston, Nathan J.
Holmes, WiUiam J.
Hastings, John G.
Helm, William D.
Hope, Thomas M.
Hamilton, Charles C.
Henry, William
Horlbeck, Peter
Johnson, Peter T.
Johnston, Madison
Jones, James S.
Irvine, James F.
Kemp, William M.
Kirk, John W.
King, Charles R.
Kennedy, Edward H.
Kerr, William
Kinsey, Jefferson
Ker, John James
King, David D.
Lathrop, Horace
Lofland, Hazlet
Lincoln, Henry
S. Carolina, Cold.
N. Carolina, Dysentery.
Pennsylvania, Scarlatina.
Virginia, Scarlatina.
Virginia, Laryngitis.
Pennsylvania, Fungus Hsematodes.
Pennsylvania, Intermittent Fever.
New Jersey, Fungus Hsematodes.
Ohio, Dysentery.
S. Carolina, Ascaris Lumbricoides.
Virginia, Intestinal Worms.
Pennsylvania, Moveable Cartilages of Knee Joint.
Georgia, Hypertrophy of Heart.
S. Carolina, Tetanus.
Virginia, Sympathy.
Virginia, Bilious Colic.
N. Carolina, Variola.
Nova Scotia, Old Age.
N. Carolina, Small Pox.
Philadelphia, Apoplexy.
Philadelphia, Iodine.
Virginia, Cynanche Trachealis.
Maryland, Hysteria.
Virginia, Calorification.
Virginia, Indigestion.
Virginia, Principles of Revulsion.
Dis. of Columb. Influence of the Mind.
N. Carolina, Mental Emotions, &c.
Maryland, Epidemic Erysipelas.
Virginia, Cynanche Laryngitis.
Pennsylvania, Variola.
Pennsylvania, Ranula.
Kentucky, Delirium Tremens.
Virginia, Remittent Fever.
Nova Scotia, Acute Peritonitis.
Pennsylvania, Cholera Infantum.
S. Carolina, Bilious Fever.
Virginia, Traumatic Haemorrhage.
S. Carolina, Inguinal Hernia.
Georgia, Acute Gastritis.
Pennsylvania, Diabetes.
Maryland,
S. Carolina,
New York,
Pennsylvania,
Pennsylvania,
Pennsylvania,
Louisiana,
Pennsylvania,
Peculiarities of Foetus.
Intermittent Fever.
Effects of Cold.
Metastasis.
Haemoptysis.
Modus Operandi of Emetics.
Hypochondriasis.
Variola.
New York, Puerperal Peritonitis.
Virginia, Jaundice.
Massachusetts, Metastasis.
Quartei'ly Medical Jidvertiser.
275
I.eltch) James A.
Longshore, Joseph S.
Leib, George C.
Lovelace, P. E. H.
Lewis, Norbone W.
M'Ruer, Daniel
Montgomery, Joseph F.
Mauck, Aaron
Malone, T. Stith
M'Daniel, Richard H.
Miller, Francis E. K.
Murphy, Charles T.
M'Nutt, Benjamin F.
Michie, James W.
M'Cantz, Robert James P.
Neves, Albert G.
Norcom, Benjamin R.
Postell, Phiiip S.
Pannill, ]3avid
Pleasants, Henry
Palmer, George W.
Philips, William
Punnett, John
Powell, Francis W.
Pitchford, Thomas J.
Porcher, Edward
Powell, Lemuel B.
Prince, Abner
Peete, George W.
Eice, Edward
Robinson, James S,
Read, Robert A.
Radford, John B.
Richardson, H. W.
Roberts, Charles B.
Ricksecker, Moses
Rasin, Edward F.
Reese, Henry W.
Smith, Joseph A.
Scales, Richard
Semple, George W. M,
Sterett, Green
Stokes, George
Taliaferro, William Q.
Taliaferro, Edmund P.
Tennent, Henry
Taylor, Isaac E.
Turnipseed, Zechariah
Taliaferro, William Jr.
Turner, Pitticus
Thomas, George W.
Virginia, Arsenic.
Pennsylvania, Digitalis Purpurea.
Pliiladelphia, Cartilages of Knee Joint.
Mississippi, Chronic Hepatitis.
Virginia, Cholera Infantum.
Maine, Inflammation of Mucous Membranes.
Virginia, Chlorine.
Pennsylvania, Fcetal Circulation.
Alabama, Animal Magnetism.
S. Carolina, Asphyxia from Drowning.
Georgia, Inflammation.
S. Carolina, Bilious Fever,
Virginia, Chemical Affinity.
Virginia, Pathology of Fever.
S. Carolina, Typhus Fever.
Virginia, Pathology of Dropsy,
N. Carolina, Nitrate of Silver.
S. Carolina, Epilepsy.
Virginia, Sympathy.
Pennsylvania, Chloride of Soda, he.
Georgia, Acute Hepatitis.
S. Carolina, Intermittent Fever.
St. Thomas, Lithotomy.
Virginia, Scarlatina.
N. Carolina, Bilious Fever.
S. Carohna, Scrofulous Ophthalmia.
N. Carolina, Pathology of Intermittent Fever.
Delaware, Acute Hepatitis.
Virginia, Strictures of Rectum.
Pennsylvania, Erysipelas.
N. Carolina, Tetanus.
Virginia,
Virginia,
S. Carolina,
Pennsylvania,
Pennsylvania,
Maryland,
Virginia,
N. Carolina,
N. Carolina,
Virginia,
Kentucky,
N, Carohna,
Virginia,
Virginia,
Delaware,
New York,
S. Carolina,
Virginia,
Virginia,
Georgia,
Functions of Liver.
Peritonitis.
Trachitis.
Rubeola.
Indications of Amputation,
Bubonocele.
Hectic Fever.
Liver and'Bile.
Puerperal Peritonitis.
Blood-letting.
Tripletts.
Dysentery.
Copper,
Digestion.
Intermittent Fever.
Haemoptysis.
Exercise.
Scarlatina.
Scarlatina.
Scarlet Fever.
Wingfield, James N.
Georgia,
Scarlatina.
216 Quarterly Medical Advertiser.
Woodworth, Robert New York, Iodine.
Wickes, Stephen New York, Spontaneous Haemorrhage.
Wall, Richard Z. R. N. Carohna, Emetics.
Watson, Beverley O. Tennessee, Acute Gastritis.
Wilchnan, Elias Pennsylvania, Intermittent Fever.
Wright, David M. N. Carolina, Revulsives.
Wooiverton, Jonathan Upper Canada, Ophthalmia.
Watson, Edwin Virginia, Puerperal Convulsions.
Wade, Elbert C. Virginia, Catamenia.
At the preceding Commencement, held July 15th, 1833, the Degree of
Doctor of Medicine was conferred upon
James L. Bunch, N. Carolina, Ascites.
John Carter, Virginia, Cynanche Trachealis.
James G, Turpin, Virginia, Gun.shot Wounds.
W. E. HORNER, M. D.
Bean of the Medical Faculty.
LECTURES ON ANATOMY, PHYSIOLOGY^
AND OPERATIVE SURGERY,
By A. L. WARNER, M. D. Baltimore.
The subscriber will resume his course on Anatomy, Physiology, and Operative
Surgery, on Monday, November 5th: to continue four months.
Lectures on General, Special, and Pathological Anatomy and Physiology,
daily; with the privilege of the dissecting room, $ 10.
Lectures on Surgical Anatomy and Operative Surgery, twice a week, $ 5.
The utility of a thorough knowledge of the human structure to the medical
student is too generally admitted to require comment, and this city affords
more ample and extensive facilities for its culture than any other in our country.
Private pupils will be received at the rate of $ 80 per annum, or $ 40 for the
winter term, payable in advance.
They will have the privilege of the Lectures, the use of a commodious office
in the neighbourhood of the University, and a valuable Medical Library.
Regular examinations will be held upon the several branches of medical study .
Baltimore^ October^ 1833.
LIBRARY OF THE MEDICAL SCIENCES.
CAREY, LEA § BLANCHARD
Have published Part IV.
or THE
CYCLOPEDIA OF PRACTICAL MEDICINE AND SURGERY.
Edited by ISAAC HAYS, M. D. Surgeon to Wills' Hospital, &c.
Containing the Articles from Amber to Anatomy^ by Drs. Dewees, Horner,
Geddings, Wood, Bache, CoifDiE, Griffith, and the Editor.
" Believing the above work will be creditable to our country, as well as useful to the profession at
large, we earnestly recommend it to the patronage of the west.'^—Transylvania Journal of Medicine
and Associate Sciences.
" We merely observe in conclusion, that we i-egard the publication of the Cyclopedia of Practical
Medicine and' Surgery, as one of the most useful undertakings for the advancement of professional
knowledge, that has ever engaged attention in this country', and we doubt not that the enterprising
publishers will receive ample encouragement."— ^a^t. Med^ and Sur. Jour, and Reviav.
THE
AMERICAN JOUHNAL
OF THE
MEDICAL SCIENCES
COLLABORATORS.
Jacob Bigelow, M. D. Professor of
Materia Medica in Harvard Univer-
sity ^ Boston.
Edward H. Bartokt, M. D. of New
Orleans.
Hetstry BRoifsoiir, M. D. of Albany ^ New
York.
Walter Chaijxtin-g, M. D. Professor of
Midwifery and Legal Medicine in
Harvard University, Boston.
N. CHAPMAif, M. D. Professor of the
Institutes and Practice of Physic and
Clinical Practice in the University of
Pennsylvania.
JoHif Redman Coxe, M. D. Professor
of Materia Medica and Pharmacy in
the University of Pennsylvania.
D. Francis Condie, M. D. of Phila-
delphia.
William: C. Daniell, M. D. of Savan-
nah^ Georgia.
William P. Dewees, M. D. Adjunct
Professor of Midimfery in the Univer-
sity of Pennsylvania.
S. Henry Dickson, M. D. Professor of
the Institutes and Practice of Medicine
in the Medical College of the state of
South Carolina.
Benjamin W. Dudley, M. D. Profes-
sor of Anatomy and Surgery in Tran-
sylvania University.
RoBLEY DuNGLisoN, M. D. Proftssor of
Materia Medica, Therapeutics, Hy-
giene, and Medical Jurisprudence, in
the University of Maryland.
GouvERNEUR Emerson, M. D. of Phila-
delphia.
Paul F. Eve, M. D. Professor of Sur-
gery in the Georgia Medical College.
John W. Francis, M. D. Late Profes-
sor of Obstetrics and Forensic Medi-
cine in Rutgers Medical College, New
York.
E. Geddings, M. D. Professor of Ana-
tomy and Physiology in the University
of Maryland.
W. W. Gerhard, M. D. of Philadelphia.
William Gibson, M. D. Professor of
Surgery in the University of Pennsyl-
vania.
R. E. GniTFnii,M..'D. of Philadelphia.
E. Hale, M. D. of Boston.
Robert Hare, M. D. Professor of Che-
mistry in the University of Pennsyl-
George Haywabd, M. D. Junior Sur-
geon to the Massachusetts General Hos-
pital.
Thomas Henderson, M. D. Professor
of the Theory and Practice of Medi-
cine in the Columbian College, Dis-
trict of Columbia.
William E. Horner, M. D. Professor
of Anatomy in the University of
Pennsylvania.
Dayid Hosack, M. D. Late Professcrr
of the Institutes and Practice of Medi-
cine in Rutgers Medical College, New
York.
Ansel W. Ives, M. D. of New York.
Samuel Jackson, M. D. Assistant to the
Professor of the Institut es and Practice
of Medicine and Clinical Practice in
the University of Pennsylvania.
Samuel Jackson, M. D. of Northum-
berland, Pennsylvania.
Valentine Mott, M. D. Professor of
Pathological and Operative Surgery
in the College of Physicians and Sur-
geons, New York.
James Moultrie, Jr. M. D. Professm'
of Physiology in the Medical College
of the state of South Carolina.
Reuben D. Mussey, M. D. Professor
of Anatomy and Surgery in Dart-
mouth College, New Hampshire.
T. D, Mutter, M. D. of Philadelphia.
R. M. Patterson, M. D. Professor of
Natural Philosophy in the University
of Virginia.
Philip Syng Physick, M. D. Profes-
sor of Anatomy in the University of
Pennsylvania.
Thomas Sewall, M. D. Professor of
Anatomy and Physiology in the Co-
lumbian College, District of Columbia.
Ashbel Smith, M. D. of Salisbury,
North Carolina.
A. F. Vache, M. D. ofNeiv York.
John Ware, M. D. Assistant Professor
of the Theory and Practice of Physic
in Harvard University, Boston.
John C. AVarren, M. D. Professor of
Anatomy and Surgery in Harvard
University, Boston.
J. Webster, M. D. Lecturer on Ana-
tomy and Surgery, New York.
Thomas H. AVright, M. D. Physician
to the Baltimore Alms-House Infir-
mary.
EDITOR— Isaac Hays, M. D,
TO READERS AND CORRESPONDENTS.
Communications have been received from Drs. Baktonj Heustis, Vox dem
BuscH, Eve, Fosgate, Perrine, Charlton, Ramsat, and C. A. Lee.
The following' works have been received: —
Transactions of the Medical Society of the State of New York. Vol. 11. Part
I. Albany, 1834. (From the society.)
An Account of Jane C. Rider, the Springfield Somnambulist: the Substance
of which was Delivered as a Lecture before the Springfield Lyceum, January
22d, 1834. By L. W. Belden, M. D. Springfield, 1834. (From the author.)
Jahres-Bericht liber das Clinische Chirurgish-Augenarzliche Institut der Uni-
versitat zu Berlin, abgestattet vom Director der genannten Anstalt Dr. Carl
Ferdhstand von Graefe. Berlin, 1832. (From Dr. Von dem Busch.)
Die Behandlung der Asiatischen Cholera durch Anwendung der Kattle. Von
Dr. JoHANN LuDwiG Casper. Berlin, 1832. (From Dr. Von dem Busch.)
Sul Commercio Sanguigno tra la Madre e il feto Lezione di Tommaso Bian-
ciNi. Pisa, 1833. (From Professor Geddings.)
Medicinalbericht des kbn'igl. preuss. Medicinal-Collegiuras der Provenz
Sachsen fiir das Jahr 1830, Zus-ammengestellt von Dr. August Andreae,
kbnigl. Medicinalrathe und Lehrer an der Med Chir. Lehranstalt zu Magde-
burg. Magdeburg, 1831. (From Dr. Von dem Busch of Bremen.)
Die Behandlung der Cholera in ihren verschiedenen Perioden und Graden
von Dr. Ernst Barchewitz. Danzig, 1831. (From Dr. Von dem Busch.)
Mittherlungen iiber die Asiatische Cholera. Von C. P. Holscher, M. D.
Hanover, 1831. (From Dr. Von dem Busch.)
Skizzen und Bemerkungen von einer Reise und dissen Umgegend im Au-
gust und Sept. 1831, im Auftrage der konigl. hanov. Immediat-Commission
gegen die Cholera unternommen vom Dr. Louis Strometee. Hanover, 1832.
(From Dr. Von dem Busch.)
Letter to the Physicians of France on Homseopathy. By the Count des
GuiDi, M. D. &c. Translated from the French, by Walter Channing, M. D.
New York, 1834. (From the translator.)
Topographical Description and Historical Sketch of Plainfield, in Hampshire
County, Massachusetts, May, 1834. By Jacob Porter. Greenfield, 1834.
(From the author.)
Address to the Horticuhural Society of Maryland. By John H. B. Lateobe.
I May 15th, 1834. (From Dr. J. C. Cohen.)
First and Second Annual Reports of the Fellenberg Academy. Greenfield,
1834. (From Jacob Porter, Esq.)
L 24*
282 TO READERS AND CORRESPONDENTS.
Catalogue of the Trustees, Faculty, and Students of the Medical College of
the State of South Carolina. Charleston, S. C. (From Professor Frost.)
Chemistry, Meteorology, and the Function of Digestion, considered with re-
ference to Natural Theology. By Wiixiam Pbout, M, D., F. R. S., Fellow of
the Royal College of Physicians. Philadelphia, Carey, Lea & Elanchard, 1834.
(From the pubhshers.)
Essays on some of the most important Articles of the Materia Medica, com-
prising a full account of all the New Proximate Principles, and the Popular Me-
dicines lately introduced in Practice, detailing the Formulas for their Prepara-
tion, their Habitudes and Peculiarities, Doses and Modes of Administration;
with Remarks on the most eligible Form of their Exhibition: to which is added
a Catalogue of Medicines, Surgical Instruments, he. &c. adapted for a Physician
at the outset of his Practice, with the Doses and Effects attached to each Medi-
cine, &c. &c. By G. W. Carpenter. Second edition, revised and enlarged.
Philadelphia, 1834. (From the author.)
A Discourse on Quackery, read before the Massachusetts Medical Society at
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Boston, 1834. (From the author.)
An Address delivered to the Graduates of Washington Medical College,
Baltimore, at the Annual Commencement, on Monday, March IT'th, 1834. By
Samuel AififAi!f, M. D. Professor of Anatomy and Physiology. Baltimore, 1834.
(From the author.)
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CONTENTS
ORIGINAL COMMUNICATIONS.
ESSAYS.
Art. Pa6b.
I. Remarks on Tic Douloureux. By N. Chapman, M. D. Professor of the
Institutes and Practice of Physic and Clinical Practice in the University
of Pennsylvania -- 289
II. Reports of Cases treated in the Baltimore Alms-house Infirmary. By
James Henry Miller, M. D. Physician to the Institution - - - 321
HI. On the Pneumonia of Children. By W. W. Gerhard, M. D. of Phila-
delphia. [Part 1st] 328
IV. Observations on Elephantiasis. By C. W. Pennock, M. D. of Phila-
delphia - 347
v. On Belladonna in Pertussis. By Samuel Jackson, M. D. of Northum-
berland, Pennsylvania - 364
"VI. Case of Ununited Fracture, successfully treated by Friction. By Isaac
Parrish, M. D. one of the Surgeons to the Wills' Hospital for the Relief
of the Lame and Blind 372
VII. A Case of Hypertrophy of the Mammse. By S. C. Huston, M. D. Re-
sident Physician in the Philadelphia Alms-house _ - . . 374
Vni. An Endeavour to show that the Cholera, which existed on Folly
Island, near Charleston, neither Arose from nor was Propagated by
Means of Contagion. By E. C. Keckely, M. D. of Charleston, S. C. 377
IX. Remarks on Lithotomy, by C. R. Finley, M. U. Surgeon, U. S. Army 382
X. Cases of Neuralgia, treated by Galvanism. By Thomas Harris, M. D.
Surgeon U. S. Navy, and one of the Surgeons of the Pennsylvania Hos-
pital - 384
XI. Instance of Destruction of the Uterus, Perineum and Rectum, after ^
Delivery, with Recovery. By Dr. John Swett, of Ridgway, New York 387
► REVIEWS.
II. Embryologie ou Ovologie Humaine, contenant I'Histoire Descriptive
et Iconographique de I'CEuf Humain. Par Alf. A. L. M. Velpeau, Chirur-
gien de I'Hopital de la Pitie, Agrege a la Faculte de Medecinede Paris,
Professeur d'Anatomie, d'Accouchemens et de Medecine Operatoire,
Chevalier de la Legion d'Honneur, Membre de I'Academie Royale de
Medecine, de la Societe Medicale d'Emulation de Paris, Correspondant
des Societes Medicales de Tours, Louvain, Rio Janeiro, See. Sec. Accom-
pagnee de quinze planches, dessinees et lithographiees, par A. Chazal.
Paris, 1833. Fol. pp. 104.
Embryology, or Human Ovology, containing the Descriptive and Icono-
graphic History of the Human Ovum. By Alf. A. L. M. Velpeau, &c. kc.
Graphic Illustrations of Abortion and the Diseases of Menstruation. Con-
sisting of twelve plates from drawings engraved on stone, and coloured
by Mr. J. Perry, and two copperplates from the Philosophical Transac-
286 CONTENTS.
Art. Page.
tions, coloured by the same Artist; the whole representing forty-five
specimens of Aborted Ova and Adventitious Productions of the Uterus,
with preliminary Observations, Explanations of the Figures, and remarks.
Anatomical and Physiological. By A, B. Granville, M. D., F. R. S. &c.
London, 1834. 4to. pp. 52 389
XIII. Illustrations of the Elementary Forms of Disease. By Robert Cars-
well, M. D. Professor of Pathological Anatomy in the University of Lon-
don, &c. London, 1833. Parts 1, 2, 3 418
BIBLIOGRAPHICAL NOTICES.
XIV. Observations on Injuries and Diseases of the Rectum. By Herbert
Mayo, F. R. S. Surgeon to the Middlesex Hospital. London, 1833. pp.
220. oct. 435
XV. An Investigation into the Remarkable Medicinal Effects resulting from
the External Application of Veratria. By Alexander Turnbull, M. D.
London, 1834. pp. 96 440
XVI. Transactions of the Medical Society of the State of New York. Vol.
II. Part I. To be continued annually. Albany, 1834. 8vo. pp. 176 442
XVII. An Account of Jane C. Rider, the Springfield Somnambuhst: the
Substance of which was Delivered as a Lecture before the Springfield
Lyceum. By L. W. Belden, M. D. Springfield, 1834. pp. 134. 12mo. 445
XVIII. Clinical Observations on the Constitutional Origin of the various
Forms of Porrigo, commonly known by the names of Scald-head, Tinea,
Ring-worm, &c. With Directions for the more Scientific and success-
ful Management of this usually obstinate class of Diseases by a Treat-
ment consisting of an Appropriate Modification of the Principles first
particularly promulgated by Mr. Abernethy. By George Macilwain,
Surgeon to the Finsbury Dispensary, St. Ann's Society, and late Sur-
geon to the city of London Truss Society. London, 1834 - - 458
XIX. Sul Commercio Sanguigno tra la Madre et il feto Lezione di Tom-
maso Biancini, Prosettore e Ripetitore di notomia umana nell' L E. R.
Univer. di Pisa, &c. detta all' Academia Medico-Fisica Fiorentia Nell'
adunanza del di 9 Dicembre, 1827. Pisa, 1833. 8vo. pp. 78.
On the Sanguineous Connexion between the Mother and Foetus. By Tho-
mas Biancini, of Pisa, read before the Medico-Physical Academy of Flo-
rence at its Session of December 9th, 1827 459
QUARTERLY PERISCOPE.
FOREIGN INTELLIGENCE.
Anatomt.
Page.
1. Case of Diverticulum of the
CEsophagus - - - 461
2. Case of Epispidia. By Dr. Cra-
mer ib.
3. Case of Congenital Malforma-
Page.
tion of the Brain. By M. Des-
champs - - - - 462
4. Case of Displacement of the
Orifice of the Urethra in a Young
Girl. By Dr. Otto - - ib.
CONTENTS.
287
Phtsiologt
Page.
5. Sympathy between the Uterus
and Mammse. By Dr. Rigby 462
6. Case of Vagitus Uterinus, be-
fore and after the Rupture of the
Membranes. By Dr. Heyfelder 463
7. Memoir upon the Structure of
the Lymphatic Vessels. Read
Page.
at the Medical Society of Emu-
lation of Paris, at its Meeting on
the 2d of October, 1833. By
Professor Mojon - - 464
Case of Contraction of the
Uterus after Death. By Dr.
Trustedt - . - . 465
Patholoȴ.
9. On the Pathology of Typhus
Fever. By Professor Bouillaud 465
10. M. Bouillaud on Follicular
Enteritis - . . . 467
11. On Chronic Gastritis. By Dr.
Stokes - ... 469
12. Spontaneous Perforations of
the CEsophagus and Trachea.
By Dr. Albers - - - 471
13. On the Mechanism of the Pro-
duction of Pulmonary Emphy-
sema, and on some of the Effects
of Chronic Bronchial Inflamma-
tion. By David Craigie, M. D. 472
14. Death Caused by the Opening
by Ulceration of a Blood-vessel
in the Stomach. By M. Mones-
tier
15. Vaccination. By M. Brachet
16. R&» Vaccination of the Prus-
sian Army. By Von Wiebel
17. Re-Vaccination. ByM. Lurott 475
18. Ulcerations of the Intestines
cicatrized. By M. Sedillot
19. Note of a Case in which Thir-
teen Ounces of Cerebro-Spinal
Liquid was Found. By M. Mon-
tault - - - .-^'
20. New Theory of the Formation
of Tubercles. By M. Breschet
21. On the Means of Preventing
Scarlatina. By M. Miguel, M. D. 479
474
ib,
ih
477
478
Matekia Mebica.
22. Some Remarks on the Plant
which yields the CascarillaBark.
By David Don, Esq. - - 480
23. Febrifuge Properties of Sali-
cine. By M. Richelot - 482
24. New Anthelmintic. Spigele
anthelmintique, or Arapabacca.
By M. Noverre - . - ih.
25. Active Principle of Sarsapa-
rilla. By M. Batka - - 483
By M.
26. Extract of Guaiacum.
Soubeiran . - _
27. Experiments on the Therapeu-
tic Properties of Codeine. By M.
Barbier - . . -
28. First Effect of Cataplasms on
the Skin produced forty-eight
Hours after their Removal. By
T. W. Chevalier, Esq,
Practice of Medicine,
29. Treatment of Acute Gastritis.
By William Stokes, M. D. - 485
30. Treatment of Chronic Gastri-
tis. By William Stokes, M. D. 488
31. On the Use of Blisters. By
Wilham Stokes, M. D. - 494
32. On Delirium Tremens. By Dr.
Stokes - ... 495
2>2). On Mammary Abscess. By Dr.
Beatty ....
34. On the Treatment of Porrigo
Decalvans by Solution of Tartar.
By Dr. H. Beauchamp
S5. Neuralgia. By M. Roux -
36. Hydrophobia. By M. Buisson
o7. Tracheotomy in the Last Stage
of Croup. By M. Trousseau
483
484
ik
496
497
ih.
ih
498
Ophthaxmoiogt.
38. Observations and Reflexions
upon Amaurosis, communicated
by M. A. Berton, First Assistant
Surgeon to the Municipal Guard
of Paris . ... 498
39. Nutrition and Diseases of the
Humours of the Eye. By Bour-
jot - - - - - 501
288
CONTENTS.
SURGEKT.
Page.
40. Hydrocele cured by Tincture
of Iodine. By M. P. Record 501
41. Resection of Bones in Un-
united Fractures. By M. Dupuy-
tren 502
42. On the Use of the Trepan in
Tooth-ache - . . iJj.
43. Treatment of Fractured Limbs,
by Inclosing- them in Plaster
Moulds, &c. By Dieffenbach 503
Page.
44. On Bony Union of Fractures
of the Necic of the Thigh bone.
By Sir Astley Cooper - 504
45. Amputation with a Single Flap.
By Dr. Legros - - - 506
46. Case of Osteo-sarcoma of the
Left Upper Maxillary Bone, in
which the whole of the Diseased
Bone was Removed. By M.
Blandin - - . _ t6.
MlBWIFEKT.
47. Case of Destruction of the
Neck of the Uterus, with com-
plete absence of the Os Uteri.
Vaginal Caesarian Operation.
By Dr. Caffe - -
48. Case of Accumulation of Air
509
in the Uterus simulating Preg-
nancy. By J. Jones - - 510
49. On the Impediments to Easy
Delivery, from some Malforma-
tion of the FcEtus - - 511
Medical Statistics.
50. Statistical Views of the Mor-
tality in Various Countries in
Europe - ~ - - 5\\
51. Statistics of Lithotomy at the
Hospital of Incurables, at Na-
ples, for thirteen years. By Sal-
vatore de Renzi, M. D. - 516
Chemistry.
52. New Alkaloids — Sarsaparil-
line. By M. Thubeuf - 516
53. New Researches on the Com-
position of the Serum of the Hu-
man Blood. By F. Boudet 518
54. Composition of Serum — Sero-
lin. By M. Boudet - - 521
55. Presence of Azote in all Seeds.
By M. Gay-Lussac - - 522
AMERICAN INTELLIGENCE.
Medical Education in Georgia.
[Extract of a Letter from Paul
F, Eve, M. D. Professor of Sur-
gery in the Georgia Medical
College, to the Editor] - 523
Case of Spinal Irritation. By Dr.
Andrew Nichols, of Massachu-
setts - - - - 524
Tumours of the Neck. By N. R.
Smith, M. D. Professor of Sur-
gery in the University of Mary-
land .... 526
Claims of British Surgery, to the
Triumph of First applying a Li-
gature to the Common Iliac with
Success - - - - 529
Surgical Novelties - - 530
Table exhibiting the Doses and
Properties ascribed to the Prin-
cipal Medicines and Officinal
Preparations. By Professor Dun-
glison .... ih.
Testimony to Professional Merit ib.
Transylvania University - ib.
Medical College of the State of
South Carolina - - ib.
University of Virginia - ib.
New Pubhcations - - ib.
Ixkex 531
Advebtisements - . - 535
THE
AMERICAN JOURNAL
OF THE
MEDICAL SCIENCES.
Art. I. Remarks on Tic Douloureux; with Cases. By N. Chapman,
M. D. Professor of the Institutes and Practice of Physic and Clini-
cal Practice in the University of Pennsylvania.
1 HIS is the earliest of the titles conferred on a nervous affection of
a peculiar nature, which seems to have attracted attention only in
very modern times. It is true, that to so remote a date as that of
the Arabian writers of the eleventh century, the recognition of the
disease ig by some assigned, while others pretend more distinctly to
find it in the works of Ludwig and Degener, printed in 1673 and
1724. Of the precise claims of these authorities to priority in this
respect, having had no opportunity of consulting them, I am unable
to determine: but they are slenderly urged, and probably rest only
on slight hints, or rude sketches of some nervous affection, which by
a too liberal construction, are made to apply to the one now under
review.
It is commonly conceded, that the merit of first noticing it, is due
to M. Andre of France, by whom some account of it was published
about the middle of the last century.* That however it previously
existed, there can be no doubt, and among other evidence to this pur-
port, which has been appealed to, is the statement of a case treated
by the celebrated Locke, the metaphysician, who in early life studied
and occasional!}^ practised physic.
The notion entertained at present by many, of its being a new
»
* 1756.
No. XXVIIL— August, 1834. 25
290 Chapman on Tic Douloureux.
disease, may have arisen from the want formerly, of careful or exact
observation, so that it was confounded with some of the varieties of
rheumatism or gout, or tooth-ache, or clavus hystericus, or inflam-
mation of the lining membrane of the antrum maxillare, which, with
other affections it simulates, and indeed, does exhibit itself under
these several guises. Yet it cannot be denied, that diseases are
newly developed, or become more prevalent at certain epochs — and
perhaps in a greater sensibility of the nervous system from the higher
refinements of recent times, excited by other and more specific causes
hereafter to be enumerated, this particular affection has increased, as
is supposed.
Twenty years* after the publication of Andre to which I have re-
ferred, a fuller and more accurate history of the disease was given by
FoTHERGiLL, to which he affixed the name of Faciei Morbus Nervorum
Excrucians, and subsequently much may be found concerning it,
either in distinct treatises, or in reports of cases, throughout the
periodical journals.
Neuralgia, the title bestowed on the affection by Chaussier, is now
most commonly adopted. But it, which strictly means nerve-ache,
is not sufficiently distinctive, since there are various other painful
nervous irritations comprehended under it, differing materially from this
one. The term too, has been absurdly extended by some recent writers,
to affections in which the incident of pain is wanting — and indeed, so
vague has become the use of it, that we hear it in common parlance,
at least, appropriated to whatever is not exactly understood in the
disorders of the nervous system. Taking neuralgia as a generic title,
we shall still require an epithet to denote the peculiarity of this
variety of disease, and the compound tic douloureux does it very
happily, indicating as well the pain, as the kind of it, which latter is
most truly its pathognomonic symptom.! The appellation it received
from Fothergill is no less objectionable, as it is expressive only of its
location in the nerves of the face, to which it is not by any means
restricted. Contrary to former views, it is of late irrefragably esta-
blished, that though most frequently met with in the three great divi-
* 1776.
•j- Of the origin of the term tic we are not quite certain. It is most probably
an onomatopy^ or sound denoting the action it imports. Thus, we say the tick
of a watch, as expressing precisely the character of the stroke, and it may, for
the same reason be conjectured, that the name tick is given to an insect, the
bite of which is singularly pungent and vibratory. Hence then, by analogy, the
application of the term to this nervous affection, it being, as we shall presently
see, characterized by a similar painful sensation.
Chapman on Tic Douloureux. 291
sions of the fifth and in the facial portion of the seventh pair of nerves,
there is no one, whether cerebral, spinal, or ganglionic, entirely ex-
empt from its attacks. Nor is it less true, that originating in any one of
the centres of the nervous system, it may be transmitted through a
nerve to its ultimate distribution, or conversely, arising at its extre-
mity, be reflected back on its centre. Existing in either of these
modes, the disease presents its simplest form: but it sometimes en-
tangles other nerves of the same, or those belonging to a different
class, and then of course the case has a far more complex aspect.
By reason of these circumstances the disease is considerably diver-
sified, and it receives further modifications from the tissue or organ
in which it may be seated, as well as the variations of its stages. To
delineate it in each of its presentations, would occupy a larger space
than I can with any propriety appropriate, and hence I must be con-
tent with a general sketch.
Neuralgia, the title which in conformity to established usage I am
compelled to adopt, may come on suddenly and without any premo-
nition. But it usually is preceded by some considerable disturbance,
and especially of the stomach and collatitious organs, amounting oc-
casionally to confirmed dyspepsia — while in other instances, uterine,
arthritic, or other derangement and its consequences are more con-
spicuously displayed, and such condition of impaired health will en-
dure for a great length of time before an attack. Neuralgia in the
commencement is decidedly paroxysmal, becoming less so in its
chronic state of long duration, and has been repeatedly seen to ob-
serve with exactness in its returns the law of periodicity, so far
imitative of intermittents in their several types.
As immediately precursory of an actual aggression in this shape,
some sense of chilliness, with slight disorder of stomach, and palor
of skin are often to be noticed, or without such marked affections, a
general uneasiness is experienced— and I have known it to be pre-
ceded for months by a slight thrill or creeping sensation, like formi-
cation, or the aura epileptica, passing with great rapidity in the direc-
tion of a nerve and its ramifications. Yet in as many cases prelimi-
nary indications are wanting, and the paroxysm is ushered in by an
ache in the part, soon aggravated to intense poignant, darting pain
from the incipient point along the nerve and its distributions.
The direction of the pain is influenced by the course of the nerve
affected. It may be seated in the second branch of the fifth pair
or in the superior maxillary nerve, and here it will be found over the
cheek bone, just beneath the orbit of the eye, or in the alae of the nose^
292 Chapman on Tic Douloureux.
upper lip, gums and teeth. Displayed in the forehead, temple,
inner canthus of the eye or the globe itself, the ophthalmic branch of
the fifth pair is affected, and when there is a copious effusion of tears,
which sometimes happens, it is not improbable it arises from a twig
of the ophthalmic, which goes to the lachrymal duct. Extending to
the lower jaw or tongue, the third branch of the fifth pair is also im-
plicated. As frequently, perhaps, more so, with the pain already
described, do we find it in the ear, the mastoid process of the tem-
poral bone and the angle of the lower jaw. This being the case, the
recurrent branch of the fifth, and the portio dura are both concerned: but
so intimate is the connexion of most of these nerves, that in a large
proportion of instances of any length of persistence, the whole of them
are apt in some degree to be involved. The agony is sometimes so
extreme, as scarcely to be borne, inducing even a distracted or
phrensied state of mind. Commonly, however, the suffering is not
so great, and between the transient paroxysms there are remissions
bringing with them comparative ease. The part is so exquisitely sen-
sitive that the lightest touch cannot be tolerated, even less than firm
pressure, and never fails to renew the excruciating dartings. Cases
of recent origin particularly, are said sometimes to be attended by
turgescency of the vessels of the affected part with some rubescence,
or as is affirmed, by actual phlogosis, which, however, I have never
seen — and occasionally, there is spasm or at least twitchings or vellica-
tions of the adjacent or remoter muscles. The circulation undergoes
no material change, or not greater than might be supposed from the
mere pain or the stimulating remedies usually employed. Decided
fever, perhaps, never takes place. The duration of the attack is very
indefinite, from one or two hours to several days, and its recurrence
or exacerbation is alike in the day and night. Going off by gradual
abatement, it leaves the part for some time afterwards either very-
tender or moderately sore, and without any further suffering or in-
convenience.
Equally uncertain is the period of its return. As intimated, its
revisitations are sometimes as regular as those of intermittents. But
such instances are rare, and the interval may be a week, a month, a
year or more, much depending in this respect on the nature of the
cause, whether permanent or otherwise, or the degree of exposure to
the excitements of an attack, or the case being acute or chronic, in
which latter state the affection ultimately becomes nearly continued.
The preceding account regards more immediately the commonest
variety of the disease, that of the face for which the name tic dou-
Chapman on Tic Douloureux. 293
loureux is still retained bj some writers. But it may be manifested
in any or every part of the body, external as well as internal, by the
acutest pain or soreness merely of the scalp on one side only, or in
the occiput or frontal portions, or in a great degree throughout the
tegumentary tissue, apparently not penetrating deeper than the sen-
tient surface,* or in the intercostal muscles, or those of the shoulder,
loins, hip, and extremities, upper and lower, pursuing the course of
their respective nerves, sometimes to the ends of the fingers or toes,
or expanded over the palms of the hand or soles of the feet.t
Locations of the disease in the large articulations are common oc-
currences,:}: while on other and less frequent occasions, the smaller
are its seat. It is sometimes to be met with in the testicles, § and
still oftener in the mammse-H An attack may be confined to a mere
spot. Thus, in one instance it occupied a space on the finger so
small that it might be covered with a pea.
No one organ of the great cavities has any immunity from the dis-
ease. The brain does not wholly escape — the lungs, with their ap-
pendages, are frequently attacked — and the heart is still more exposed
to its aggressions. Nearly, or perhaps quite as much, are the abdo-
minal contents, the stomach, the upper and lower bowels down to
the rectum, the liver, the spleen, the kidneys, the urinary bladder,
* Not the least remarkable case of this kind came under my own observation.
Many years ago, I was consulted by a lady, who informed me, that after having
suffered severely from neuralgia of the hip and lower extremity, she was seized
periodically with exquisite tenderness of the skin, attended by an intense burn'
ing" sensation, and occasional darting pains in various directions.
■j- This is the neuralgia pedis oi Good,2ind the neuralgia planiaris o^ Cha.\issier,
I have seen it both in the hand and foot. It is mostly confined to the palm or
sole, though now and then shooting pains are felt up the limb.
^ Tt occurs most frequently in the knee. M'Culloch remarks that it is apt
to be mistaken for white swelling, and it is described by Brodie under the title
of hysterical white swelling. My own cases of it had no analogy to that affection^
and might more likely have been confounded with chronic rheumatism. They
differed, however, from it in the total absence of tumefactions and by the pe-
culiarity of the pain.
§ Of this, I have known two instances, one in consultation with Dr. Physick.
It is to be recognised by the characteristic pain, the absence of swelling and
other changes in the testicle, and by uneasiness in the lumbar region.
11 This is an affection for which I have been so often consulted, that I should
presume it to be common. It has heretofore been very much regarded as
rheumatism. The breast undergoes no alteration: but from a centre, as it
were, lancinating pains emanate, extending to the side, sometimes up the head,
and down the arm. Tenderness on percussion is usually betrayed at one point
of the cervical vertebrae,
25*
294 Chapman on Tic Douloureux,
and above all, the uterus and its dependencies have been noticed as
affected in this way.*
Not to descend into details which were foreign to my design, and
more particularly as I have hereafter to expatiate to some extent on
the subject, it may be sufficient now to remark, that the affection
wherever it is fixed, though in some measure modified by the pecu-
liarities of the nerves or general structure, exhibits essentially the
same features, and is observant of similar laws. Nearly in every in-
stance there may be recognised the influence of identical causes in
its production — the characteristic pain, distinct and peculiar — its
transient or more fixed nature, together v/ith the several varieties in
regard to the entire paroxysm — the gradations of severity, its duration,
the interval between its recurrences, and the mode, whether stated,
or at irregular and uncertain periods. The leading differences when
thus existing, are its greater proneness to fluctuation — sometimes
very rapidly changing its position — that it is more apt to involve
several nerves at a time, giving to it a wider pervadence, and that
the pain is usually far less intense than in the affections of the face.
Neuralgia is chiefly incident to middle or rather more advanced
age, from the fortieth to the sixtieth year of life, and mostly occurs
in the female sex, of delicate irritable nervous habits or shatter-
ed constitutions. Exceptions however exist to these general rules.
It is occasionally met with in persons of vigorous frames and the
soundest health, and even in boys and girls. There is, indeed,
a mitigated form of it to which the latter are very liable at the season
of puberty or a little later, associated with much disorder of system.
In reviewing the etiology of neuralgia, we can hardly avoid being
struck with the number and diversity of the causes to which it has
been ascribed. No doubt is longer entertained that these operate on
the centres of the nervous system, or on the extremities of their re-
spective nerves, the impression being reciprocally reflected. As such
i& the fact it were desirable to make this consideration the basis of
an arrangement of them. But I am discouraged from the attempt
by its difficulty, enhanced by the narrowness of the limits allowed
to this brief discussion. My design, at present, is to bring them
under two heads, dividing them into such as are local and general.
* Cases of nearly all these varieties I have met with : but the uterine are
most familiar to me. Girls about the season of menstruation are peculiarly sub-
ject to such attacks. They are often periodical, the paroxysms returning daily
or more irregularly for several days at a time, and then disappear. The pain
is truly neuralgic, darting from the uterus through the pelvis, to one or both
iliac regions. Tenderness of the lumbar vertebrae will sometimes be detected.
Chapman on Tic Douloureux. 295
Belonging to the former description are mechanical injuries of the
nerves, inflicted by wounds, excised, lacerated, punctured or con-
tused. Examples to this purport are abundantly recorded, some few
of which I shall mention. There is a case related, arising from a cut
in the arm with a knife — a second by a cut in the cheek from a piece
of China, which remained concealed in it — a third from the bite of
the little finger by a child — a fourth from laceration of the hand by
an explosion of gunpowder — several from the puncture of the lancet
in venesection, and two instances by a blow in the eye and on the
sinciput. Cases are also to be met with, which followed surgical
operations, particularly amputations, attributed to the irritation of the
excrescent tubercle formed on the end of a divided nerve. Tumours
under other circumstances, are a still more frequent cause of the dis-
ease.
Nor is it less determined that it proceeds from lesions of bones, ope-
rating by the irritation of spiculae or other asperities, or by the acri-
*mony of the fluids when caries prevails, which conjecture is rendered
probable by other foul ulcers having had an analogous effect. Cases
in proof of this have been published by Dessault, Sir H. Halford,
and among others which might be cited, is the memorable one of Dr.
Pemberton, the origin of which was traced to an abscess in the
frontal sinus. Much such a case has recently been under my care,
which, however, terminated far more happily. Great mischief in this
way is undoubtedly occasioned by compression. Not usually incident
to lateral curvature or caries of the spine, it has sometimes been as-
certained in connexion with both. The pressure of the head of the
child in parturition certainly has induced it, most usually in the rec-
tum, having seen it myself independently of other proofs of the fact
which are extant. But far more operative is the fashionable corset.
By tight-lacing, either the intercostal nerves, or the spinal marrow
itself, becomes irritated, from which I have again and again remarked
very severe neuralgic distress. That it, particularly when of the
facial form, is dependent on dental irritation, and more generally
than suspected I am persuaded, as well from my own observations
as those of other practitioners.
Of the more general agencies in the production of neuralgia, the
first which claims to be noticed, from the importance recently attached
to it, are marsh miasmata. By Macculloch, indeed, who has brought
to the elucidation of the subject great fidelity of observation, and
industry of research, with adroitness in the collation and analysis
of testimony, the hypothesis is presented with such plausibility, that
296 Chapman on Tic Douloureux.
it can scarcely be resisted. Not prepared to go the extent to which
he applies it, for in the ardour of generalization, he seems disposed to
exclude almost every other influence, I think he has shown as well the
affinities to the neuralgic disturbances, of numerous affections hitherto
deemed dissimilar, as that the immediate malarious source of the lat-
ter, is infinitely wider spread than had ever been suspected. Examples
in proof of these positions he adduces from his own and the observations
pf others, that independently of some powerful reasoning, his conclu-
sions with due qualifications, are satisfactorily made out and established.
The recollection of my own practice furnishes no inconsiderable
amount of evidence corroborative of the conviction to which I have
arrived. During the prevalence of pernicious and anomalous inter-
mittents among us some years ago, I repeatedly saw the paroxysm
assuming the varied shapes of neuralgia^ that of the optic and facial
nerves, sometimes as hemicrania, on other occasions in the limbs, or
the muscles of the abdomen, and also instances in the organs of the
large cavities, especially in the latter, when the attack had become'
chronic, usually accompanied by the aspect and condition expressive
of the protracted operation of palludal exhalations. Not the least
curious of these instances was related to me by my friend, the late
venerable Dr. Belville of Trenton, where the tip of a single finger
in himself was for many weeks seized at precisely the same hour of
the day with genuine tic douloureux, which having resisted diverse
local applications, came promptly to be remedied by the sulphate of
quinine.
As among the occasions of the disease, inordinate venereal indul-
gence cannot be omitted. Legitimately practised to excess, it may
be productive of this effect, though much oftener it is to be traced to
a criminal habit too disgusting to be more distinctly expressed, which,
while operating to the derangement of the whole nervous system, is
chiefly displayed in its severest form in the loins, lower extremities,
and head.
Constitutional disorder from causes not so apparent, seems also to
originate or conduce to the disease. Cases of it are habitually seen
associated at least with those depravations of the digestive apparatus,
bearing the nearest affinity to, or even the semblance of identity
with the multitudinous and protean affections, which by a sweeping
generalization, are embraced under the vague term of dyspepsia.
We learn indeed from good authority, that a '* careful review of all the
published cases of neuralgia shows, that more than three-fourths of
them manifested general disorder of health, and especially of the di-
Chapman on Tic Douloureux, 297
gestive organs."* But while this is conceded, it is no less true, that
it may be produced by lesions of any of the internal organs, or sys-
tems of organs, and especially of the uterus, by which the general
condition of health is impaired. There is moreover great reason to
suspect that a bad habit of body, brought on by the depredations^ of
gout, and especially in its irregular and atonic forms, either lays the
foundation of, or more directly excites some of these attacks. It is
probable that not a few of the cases to which an allusion has been
made, with vitiations of the digestive organs without an obvious
cause, do thus originate in arthritic influence.
The state of anemia, whether brought on directly from excessive
sanguineous depletion, by venesection, or haemorrhage, or more
slov/ly by a penurious, impoverishing diet, or by those organic or
functional disorders which interrupt the process of haematosis, must
be assigned as a prolific source of the disease. Dependent on this
exsanguineous exhaustion, cases of it are of the most common occur-
rence. My friend Dr. Physick tells me, that he saw many such suc-
ceeding to the recoveries from yellow fever where blood-letting had
been unduly practised, and they are as frequent under alike circum-
stances of other diseases. As sequelae of haemorrhage, particularly
uterine floodings, who has not witnessed them, and not less in con-
nexion with inveterate cachexy, from vitiation of the nutritive opera-
tions? Though any part may be involved, it is mainly the head that
experiences the excruciating and peculiar neuralgic suffering.
The preceding are the principal of the remote causes of neuralgia
in its several modifications, and which often are brought into action
without the interposition of any further agency. But the latent pre-
disposition is sometimes obviously awakened, and in a case only sus-
pended, it may be immediately revived by an exposure to cold and
moisture, or a draft of cool air, or walking, or other corporeal exer-
tions, or by mental application, or by anxiety or depression of spirits—
or conversely, the active emotions, or by touching the part, and when
seated in the face or jaws, by chewing or talking, or hawking or
spitting, or coughing or sneezing, or blowing the nose, or taking into
the mouth any thing hot or cold, or sweet or acid, or washing the
face, or combing the hair, together with other excitements of an ex-
ceedingly trivial nature, even by putting on a pair of spectacles.
Neuralgia well marked, can scarcely be mistaken. Its lead-
ing and distinguishing characteristics are a peculiar pain aptly ex-
* Med. Chir. Review, for the year 1828,
298 Chapman on Tic Douloureux.
pressed by the term tic., consisting of successive shocks darting along
a nerve or nerves as rapidly as those of electricity, and as transient,
or when slighter, mere vibrations, seldom or never attended by
swelling or any apparent inflammation, the paroxysms returning pe-
riodically, sometimes as regularly as intermittents in their several
types. This however applies more to the disease in its acute form,
and especially that affecting the facial nerves. Located elsewhere,
or becoming chronic, it is more obscurely designated, though under
all circumstances, so retentive of some of its own features, as to be re-
cognised with little hesitation or perplexity.
Neuritis, and especially of the nerves of the teeth, occasioning
what is called tooth-ache, bears the closest analogy to it when seated
in the face. It may however be distinguished from ordinary and
genuine odontalgia by the character of the pain, it being in the dental
affection, deep-seated, more obtuse, and permanently enduring, ulti-
mately followed by swelling of the cheek or gums, often ending in
suppuration, or other effects of the inflammatory process. Cases
without these symptoms or events, are probably always of a pure
neuralgic nature.
To some of the varieties of rheumatism it is also said to have a
close resemblance, from which however it so materially differs, that
they need not be confounded. The seat of the latter is in the
nervous, and of the former in the fibrous and muscular tissues. Nor
are they induced by the same remote causes. Those of neuralgia are
various, and rheumatism seems to originate only in a cold, moist at-
mosphere. An attack of the first is revived by many and the slightest
circumstances, and of the second by a few and powerful influences only.
Equal contrarieties exist in the symptoms. The pain of the one is
acutely piercing, ticking, lancinating, limited in its direction, and
transient — while that of the other is a dull, gnawing, throbbing, burn-
ing ache, more diffused and steady, or enduring. Neuralgia is with-
out phlogosis or its terminations, and scarcely ever with any appre-
ciable disturbance of the circulation, and the other is as uniformly the
reverse, exhibiting in some parts the signs of the inflammatory process,
ending in effusions and extravasations. This affection of the nerves,
even when most protracted, does not impair the constitution or
particular structures like rheumatism, which leads to the most se-
rious disorganizations. Each is cu^ed moreover by opposite remedies.
But though neuralgia is distinct from other diseases, it is not so
easy to discriminate its own varieties as arising in the different por-
tions of the nervous system. Being a matter of great practical im-
Chapman on Tic Douloureux. 299
portance, I shall endeavour to bring together those signs which are
mainly relied on for its elucidation. Emanating from the encephalon,
we are told by a distinguished authority, " that the case is always
preceded and attended by manifestations of cerebral disease, such as
pain, giddiness, confusion, or some other uneasiness in the head,
more or less disorder in the functions of some of the external senses,
with symptoms of congestion or increased action in the vessels of
the brain, and sometimes by a simultaneous or sympathetic affection
of the stomach or liver, a circumstance not uncommon in many dis-
eases of the sensorium."*
As parts of the spinal column may be concerned, so do its affec-
tions vary. The symptoms of the superior cervical division are pain
in the scalp, shooting in various directions up the occipital, even to
the frontal portion, or laterally along the temples or over the face,
or sweeping behind the ears, or around the lower jaw, productive of
rigidity of the muscles, impeding its movements and those of the
head-— difficulty of speaking, or as may happen, loss of voice, with
vertigo, tinnitus aurium, and similar noises. These latter however
are rare occurrences, and are owing probably to the implication of
the medulla oblongata. As indicative of irritations of the inferior
cervical portion it may be stated, that the pain is seated in the su-
perior part of the chest, about the clavicle or scapula, or it runs
down the arm sometimes even to the fingers, or passing forward,
either the superficial integuments or the mammse in females, one or
both suffer extremely by exquisite soreness, or intense darting pains.
Many of these symptoms are common to the affection of the upper
part of the dorsal division, though it is more strikingly characterized
by pains in the intercostal muscles, or in the margin of the ribs, or
in the sternum, or epigastric region, or in the integuments behind the
xhest — the acuteness of the pain being occasionally exchanged for
lyspnoea in various degrees. Where the lower half is irritated, to-
gether with some of the preceding phenomena, there are a sense of con-
striction across the waist, and great tenderness of the parietes of the
^abdomen, attended by pains through the muscles.
In the affections of the lumbar and sacral section, we have a dull
Lche, or acute pain in the muscles of the loins, and those of the hips,
jwith the lower extremities in a state resembling that I have described
I the upper to be, with this peculiarity, that if the individual attempts
to walk, he totters or rolls, his knees giving way, feeling no security
in his step, exhibiting altogether the appearance of inebriation in his
* Armstrong.
300 Chapman on Tic Douloureux,
movements. But it is to be recollected, that different and remote
portions of the column may be at the same time implicated, and it has
happened to be affected, though in very rare instances, throughout its
whole extent.
As the spinal marrow in its different parts is concerned, so may
the ganglia or branches of the sympathetic nerve, one or several si-
multaneously, and the symptoms modified accordingly, to trace which
minutely is not my purpose. They are in a word such as denote de-
pravation of the organs deriving their nerves from this source: thus,
the heart or great blood-vessels violently palpitate, or are seized with
true neuralgic pain, the lungs suffer as in spasmodic asthma, or the
attack being more comprehensive^ we have angina pectoris. The
stomach and bowels are assailed by cramps or colics, mostly in the
shape of what is called gastrodynia, or by pains more piercing and
fugitive, not one of the abdominal viscera entirely escaping, and es-
pecially the kidneys, urinary bladder and uterus.
Connected with these various disturbances, there is often great vi-
tiation of the secretions, as witnessed in the prodigious accumulations
of flatus in the alimentary canal, or of the limpid fluid in the stomach
constituting pyrosis, or in the occurrence of the diabetic discharge,
or in the deviations of the menstrual flux, increased or suppressed or
changed even to the leucorrhoeal fluid.
Closing this analysis I have to remark, that though towards the
establishment of a diagnosis in relation to the origin of the disease in
the several sections of the nervous system, no slight assistance will
be afforded by diligent attention to the discriminating circumstances
pointed out, these must be received with some limitations of con-
fidence. Even when it arises in any one part, it is prone to implica-
tions, so perplexed and entangled, as no longer to be separated or
traced back to its primitive source. This tendency to coalition
is greatest between the affections of the spinal and ganglionic nerves — >
they, indeed, having seldom for any length of continuance a distinct
existence, though it is oftener to be observed of the former than
latter.* The most certain test of irritation of the spinal marrow is
by careful percussion or pressure, or by sponging the column with hot
water, sensibility being betrayed at some point by the one or other
means, rather I presume of the nervous twigs supplying the processes
* Thus it will be found, that almost immediately the affections of every part
of the apparatus of organic life evince such a complication. We see it con-
spicuously in colic, where the agony is as great in the back, as in the bowels,
and relief sometimes more promptly afforded by applications to the former,
than latter part.
Chapman on Tic Douloureux. 301
and arches of the vertebra and the muscles and ligaments attached
to them, than the marrow itself, enclosed as it is in a bony case.
No great encouragement have we hitherto received to prognos-
ticate favourably in this disease. Cures undoubtedly of recent at-
tacks are often effected, and occasionally, too, in the more chronic
states of it. But it as frequently, almost, has baffled our efforts, and
especially where it had become fixed and confirmed. Duration, there-
fore, exercises an influence over the curability of the disease — and
scarcely less so, determining from what I have seen, the seat it oc-
cupies, the general condition of health with which it may be associat-
ed, and above all, the cause by which it is produced, and the ascer-
tainment of that exactly. Excepting such cases as proceed from par-
tial and obvious injuries, I have found those of the spinal marrow to
prove most certainly manageable, owing probably to the facility of
detection, and the direct application of the appropriate remedies.
Coming from the brain, contrary to the language of Armstrong, I
have known it much seldomer relieved — and exceedingly intractable for
the most part, are the affections of the ganglionic system of nerves,
especially if complicated with disorder of the abdominal viscera, and
the cachectic aspect, so generally concomitant on it.
Of the propitious signs, among the most so, is the regularity with
which the intermittent character is maintained, denoting that the case
does not arise from any immoveable fixedness of cause, and when
convalescence is about to take place, it is manifested usually by a
progressive lengthening of the intervals between the paroxysms, and
a correspondent diminution of the intensity of suffering. The reverse
in these respects is of course of opposite import.
In seeking the causes of the uncertainty and want of success in the
treatment of neuralgia we shall further discover, that not less is owing
to our ill-regulated practice in it, than the intractability of the dis-
ease itself. Considered as a new, and extremely anomalous affection,
it was for a long time viewed mysteriously, and instead of investiga-
ting its pathology, efforts, purely tentative and empirical were made
for its removal. Disappointment followed, as might have been anti-
cipated, from such gropings in the dark, and though a better course
IS begun to be pursued, it is still marked rather by a propensity to
multiply the means, than to ascertain the principles on which the cure
should be conducted. Even up to the present inoment, the medical
journals teem with fresh contributions to the overgrown and redun-
dant accumulations of remedies, with very seldom a suggestion of any
value as to their peculiar adaption or the exact circumstances of their
administration.
No. XXVIII.— August, 1834» 26
302 Chapman on Tic Douloureux.
But though our skill may have hitherto been rebuked, it is conso-
latory to reflect, that the disease cannot be deemed a fatal one, and
that it often spontaneously disappears, submitting to the resources of
nature, or to agencies which we cannot supply. Numerous cases are
reported which have thus passed away, after a lengthened duration
of suffering, owing to a revolution in the constitution by time alone,
or the supervention of some other disease, particularly the eruptive,
or by a total change in the habits of life, or by a residence in a more
genial climate, or by merely a shock from terror or some other power-
ful mental emotion.
Death rarely taking place in this disease, our information is very
slender in relation to the post mortem appearances. Those which
occasionally have been met with, it is difficult to determine whether
they be cause or effect, or totally independent of this affection. As ex-
amples of this equivocal nature may be cited the cases lately reported
by Sir Henry Halford, where he found in one an exostosis of the al-
veolar process — in a second, disease of the antrum Highmorianum — in a
third, a large deposite like frost work on the internal surface of the
skull — as well as those from other writers, such as an abscess in the
frontal sinuses, or a morbid state of the foramen through which the
nerve passed, or tumours and other adventitious growths of diverse
kinds. Most likely all such disorganizations are rather the occasion
than the consequences of the disease. Though in some few instances
the nerves have been found with increased turgescency of the vessels
of the neuriiema, and preternaturally florid, or enlarged and thick-
ened, there were wanting the serum, lymph, or pus, with the general
changefe of structure incident to neuritis. Taking the results of the
whole of the dissections of which I have any knowledge, it may be
affirmed, that in much the largest proportion of the legitimate neural-
gic affections, no appreciable alteration existed, and which is very re-
markable, considering the intensity of irritation and pain endured.
Because however of no apparent, we are perhaps not entitled to infer
that there were no actual changes. The nervous organization is so
exquisite, that the difficulty of detecting its abnormal deviations is
great, and it may be added, that the disease being mostly seated in
the root, there are the derangements, which part has seldom been
inspected.
In approaching the consideration of the pathology of neuralgia, I
feel much of the embarrassment confessed by those who have been
called to encounter the disease, or have written on the subject. Thus
far however seems certain, that it commences at a point as previously
described. Nor perhaps is it less true, that while the irritation has
Chapman on Tic Douloureux. 303
generally a local, it may have also a constitutional origin. By Mr.
Abernethy it is declared, ''that the disease is as much so as gout
or rheumatism," and indeed another respectable authority* defines it
to be " a local affection having a constitutional origin." True to a
considerable extent, this view cannot be received as of universal ap-
plicability. The common coincidence of neuralgia with distempera-
ture of system is undeniable. But whether as the cause or effect, it
is in many instances difficult to determine. Be it as it may, of the
precise character of the initiatory or subsequent and consequential
actions we are not accurately informed. It has been surmised on a
review of the mode of origin, the symptoms, the autopsic appearances,
and the method of cure, that the condition varies in each particular
in different cases, and in the progressive stages of the same case.
Thus it is said, that though some attacks clearly arise from simple
irritation, and which state is throughout undeviatingly preserved, it is
equally evident that in other cases, there is occasionally inflammation
of the nerves. Granting this, it still remains doubtful whether phlo-
gosis should be deemed an essential ingredient in the neuralgic con-
dition properly defined. That the disease may start from a point, and
run its course without any cognizable degree of it, will not be denied,
and such being correct, it follows that though inflammation may
sometimes be disclosed, it is merely an effect of a preexisting irritated
state, or accidental in its occurrence, and not material to the disease,
however it shall contribute to change its aspect, or influence the
treatment. Neither simple phrenitis, spinitis, nor neuritis, present
an identity with neuralgia — these affections on the contrary, when
purely elementary or uncombined, displaj'ing the most striking dif-
ferences from it.
Discarding then, as not comporting with facts, the hypothesis so
speciously made out by Parry, Vaidy, and others, that the disease
is caused by undue vascularity and phlogosis of the nervous tissues —
.and also the notion of Armstrong, by whom it is referred to an es-
^sentially similar condition of the brain, I am led to the adoption of an
opposite conviction of its nature. Did it consist in such a state as
,they have represented, it were impossible to explain the efficacy of
-the Peruvian bark, the Martial preparations, and the ordinary plan
of treatment generally in its cure. The only distrust I entertain of
the correctness of this view, concerns the state of i\\e, punctum saliens
of the affection. Numerous examples does the history of disease supply
■of inflammation in the primary source and the secondary, and most ma-
* Palmer.
304 Chapman on 2\c Douloureux,
nifest aflFections though painful, and sometimes exclusively so, being
destitute of it. Contemplating the pathology of neuralgia in this light,
we may at least reconcile the propriety of our practice of local bleed-
ing and counter-irritation at the primarily affected part, with the sub-
sequent use of medicinal tonics and other means of corroboration.
Carefully examined, there will be found no contradiction in the pre-
ceding statement. As off*spring long survive the death of parents, so
does disease the source from which it sprung. The *' fons et origo" of
it may become extinct, and itself shall endure in unabated force.
This is indisputably true as to the neuralgic affections, and my re-
marks, which might be amenable to hasty criticism on the score al-
luded to, are vindicable as designed to apply to the incipient and en-
suing stages of the disease. Commencing possibly in inflammation of
the root, this ceases in the branches, which take on another and very
different state, enduring indefinitely often in an independent exist-
ence. Do we not habitually witness in confirmation of it, (the preju-
dicial tendency of those very remedies, local bleeding, &c. in the
chronic disease. ^
But nervous irritations vary in themselves, and lead to results of
infinite diversities, as is illustrated in the numerous diseases referred
to them as the proximate cause. Neuralgia itself seems modified by
its locations, owing probably to peculiarities in the nerves proceeding
from the several centres. Between that of the face and the visceral
organs, the most striking difference is observable, the one being seat-
ed usually in the cerebral, and the other in the ganglionic nerves.
We see this distinction as well in the kind and degree of pain, as in
the effects of remedies. To inquire into the intimate nature of neu-
ralgic irritation, were as futile and unavailing in the present state of
our intelligence, as similar scrutinies have heretofore proved in re-
gard to other diseases. The fact is, that of the entity of any patholo-
gical condition, we are utterly ignorant, and from its subtlety will
probably continue to elude our researches to all time. To say that
the irritation here is sui generis, the language in ordinary use, is
merely to repeat a barren truism, the vulgar refuge of ignorance,
whose practice it is to shelter itself under the substitution of a sono-
rous phrase for real knowledge. Looking at its phenomena we can
scarcely infer more, than that the residence of neuralgia is exclu-
sively in the nerves of sensation, and from its analogy to some of the
varieties of rheumatism, in the fibrous or exterior covering especial-
ly, having their sensibility raised to the highest pitch of exaltation,
to which circumstance many of its peculiarities may be plausibly as-
signed— in this respect, being directly the reverse of palsy.
Chapman on Tic Douloureux. 305
In regard to practical convenience, some perspicuous classification
of the neuralgic affections is much to be desiderated. The most na-
tural and advantageous, perhaps, would be to groupe them as occur-
ring in the three great divisions of the nervous system — secondly, as
confined to a single nerve or more extensively complicated — and last-
ly, as acute or chronic. But though such a scheme might be endea-
voured, I am apprehensive, insuperable difficulties would attend its
execution in the present obscurity of the subject.
The treatment of the disease in every nosological plan, must di-
vide itself into what is proper to mitigate the anguish of the paroxysm,
and in the interval, with the intention of a radical cure. Many pal-
liatives have been proposed, as venesection, leeching, counter-irri-
tants, blisters or caustics — lead plasters — lotions of a solution of the
extract of belladonna or opium — the endermic application of the ace-
tate of morphia — steaming, and emollient poultices — acupunctura-
tion — compression by a tight bandage — the internal exhibition of
opiates, colchicum, &c. &c. It were easy to collect proof of the occa-
sional efficacy of each of these remedies, though the whole as fre-
quently have proved impotent to any useful purpose. The reason of the
failure of the topical means, is probably to be imputed, in part, to
their being not always placed at the root of the affection, which is com-
monly remote from the seat of the pain. It is not easy, indeed, in any
other way to reach an explanation of such opposite results as are re-
ported of the same remedies. But there is a choice in the measures
of mitigation. General blood-letting is only useful when plethora ex-
ists, or a phlogistic condition has been superinduced by cold or other
causes reviving with exasperation the neuralgia, sometimes present-
ing a sort of mixture of rheumatism, and especially so when the
large organs, or the great centres of the nervous system, are directly
assailed. Leeching proves more generally beneficial, and cannot be
dispensed with on some occasions, of the inflammation of the neu-
ilema or of the nerve, and is one of the most effectual expedients in
xacerbations of spinal irritation. Caustics are preferable to epispas-
itics, particularly in neuralgia facialis, put behind the ears. By
steaming the part, if there be exquisite tenderness, it may be as-
suaged. The only case to which acupuncturation is fitted, is where
large muscles are involved, as those of the loins or hips, occurring
'mostly in rheumatic or gouty habits. The effect of the internal exhi-
bition of opiates, is varied by the position of the affection. Nearly
useless in neuralgia facialis, it is of the greatest service in that of the
i-ganglionic system, and above all, in the attacks of the alimentary
jcanal. Yet it is not without considerable power over the irritations
26*
306 Chapman on Tic Douloureux.
of the spinal nerves. From the external application of morphine, I
have known some success. Great reliet maj sometimes be expected
from colchicum liberally prescribed. But what on the whole will be
found as certainly as any thing else to abate the intensity, and in-
deed sometimes to break down the paroxysm, is to nauseate the sto-
mach for several hours by the tartarized antimony, or preferably, by
the sulphate of copper, or by the smoking of a cigar, where the indi-
vidual is not accustomed to the practice, or judging from a single
instance, active vomiting, which I saw on a recent occasion most
prompt and decisive. Nausea exercises an extraordinary controul
over pain — it will suspend or even subdue the agony of a paronychia,
and puking is admitted to be one of the best means in several of the
affections, as odontalgia, hemicrania, &c. not altogether dissimilar to
neuralgia, which analogies led me to this extension of the practice.
It is proper further to mention, that very lately the application of
a magnet of enormous power has proved, according to European re-
ports, wonderfully effectual in alleviating, or more decidedly con-
trolling the disease. Trials of it have just begun in this city, and
though by some it is favourably appreciated, I suspect the prepon-
derance of evidence is against it, and that it will soon turn out to be
one of those delusions so often imposed upon us, and which for a
season commands too general confidence.
From a retrospect of the history of the disease, it is obvious that
on account of its numerous causes, and the several conditions which
it assumes, as well originally as in its progress, that no uniform mode
of management in reference to its eradication, can be made of uni-
versal, or even general application to it. Called to a case, the first
inquiry should be directed to ascertain the, point of its commence-
ment, and the existing state of system. Tracing out satisfactorily
the source whence the irritation flows, an endeavour is to be made
to interrupt the stream by cutting oft' the fountain of supply, and to
effect which, some discrimination is demanded in the selection of
measures. Thus in the event of its originating in a tooth, 'or the
pressure of a tumour, or the frettings from a spicula of bone, or in
any conceivable cause removable by a surgical operation, this is to
be performed. Even the neuralgic irritations following the amputa-
tion of a limb, have in several instances been cured by a repetition
of the operation. Those cases dependent on other local injuries, as
slight wounds, which after healing irritate a nerve, are most ef-
fectually relieved by an application of a caustic to the part, with
proper dressings to convert it into a running sore.
It were useless to go through with this class of aft'ections. The
Chapman on Tic Douloureux. 307
principle having been stated, the treatment may be readily accom-
modated to the variations of individual instances without any special
instructions. There is however* one remedy I must not pretermit,
from the value formerly, and which continues in some degree to be
attached to it. Not entirely with a view dissimilar to that on which
the preceding measures are inculcated, it occurred to M. Andre, by
whom the disease was probably first noticed, to divide the offended
nerve. The reports of the eff*ect of the operations were various,
though from the whole it may be collected, that the failures greatly
preponderated. Even when relief was afforded, it proved only tem-
porary, and sooner or later the affection returned unmitigated. By
Sir Everard Home, as well as I recollect, it was suggested that the
want of permanent success in the operation is owing to the nerve
resuming its functions on the reiinion of its divided ends — a pro-
cess he demonstrated to take place in a very short time, to obviate
which objection, a portion of the nerve or a large piece of the sur-
rounding integuments, according to the position of the affection, has
since been cut away.* Thus improved, the operation is rendered
undoubtedly more eff*ectual, many cases having been recorded of en-
tire cures from it by the highest authorities, as Haighton, Aber-
NETHY, Earl, Lisfranc, Warren of our country, &c. though its
utility, on the whole, is so equivocal, that it is rarely practised. Be-
ing effectual for a time, sooner or later, here too the affection recurred
in a majority of cases. That it cannot be calculated upon with any
certainty is plain, other considerations aside, from the difficulty of
reaching the seat of the affection, or of ascertaining the precise nerve,
several branches being often simultaneously involved, and in a more
general view its value is diminished, it being susceptible of applica-
tion to only a small number of cases. Nevertheless, since it has
sometimes accomplished cures, it may still be held in reserve for
those emergencies where other resources have been exhausted, and it
can safely be attempted.
Governed by the presumptive origin of the nerves concerned in
neuralgia facialis, the proper treatment will consist in repeated topi-
cal bleeding around the neck from ear to ear, or down the cervical
vertebrae, and then of issues by the vegetable caustic, or the moxa,
in the same position—and I think I have found the latter more useful
when put over the mastoid processes of the temporal bone. No less
* Lisfranc has reported a case of neuralgia of the pericranium, occasioned
by external violence, which he completely cured by removing* a portion of the
integument of several inches in extent, embracing the entire seat of the affec-
tion.
308 Chapman on Tic Douloureux,
serviceable are these means in that modification of the affection imi-
tative of hemicrania. The efficacy of this treatment in both instances
I might readily illustrate by some striking examples, could I spare
the space for their admission.
No doubt can nov7 be entertained that a common source of neural-
gia, confined to a single part, or in its fluctuations attacking many
parts, or at once widely pervading the system, has its origin in spinal
irritation. The remedies are topical bleeding and blistering, or is-
sues, with a state of absolute rest. As to the last, I am aware that
there is some difference of opinion — but from a priori reasoning,
strengthened by actual experience, I have long been convinced that
under all circumstances of an irritated spine it is indispensably ne-
cessary to a cure.
Nearly the same course is to be pursued in the affections of the
grand sympathetic nerve, where such betray any intensity of irrita-
tion, or phlogosis, however slight, and it ought to be known, that
applications to the spine are, in some instances, more effectual here,
than to the abdomen, or directly over the organ assailed.
General bleeding in neuralgia I have found rarely of service.
Even where decided inflammation prevails, it is usually local, and
proves more submissive to remedies addressed immediately to the
part. Yet the affection may be complicated with constitutional ex-
citement, adventitious or otherwise, and in such a state the treat-
ment must be correspondently accommodated.
Entertaining different pathological views, Cotugno, Armstrong,
PioRRY, and several other writers, urge with great earnestness the
depletory and antiphlogistic plan to the fullest extent in the dis-
ease. But on trial the practice has been found as unsuccessful as
the speculation from which it is deduced is deemed erroneous, and
by very general consent it is now limited to the purpose and condi-
tion indicated.
Hitherto I have presumed an integrity of the system at large — but
as we have seen, this is very much the reverse, or it is mostly dis-
ordered in diverse modes and degrees. Before, therefore, instituting
any practice regarding the neuralgia itself, that state of system origi-
nating it, or by which it is maintained, is carefully to be examined
and rectified, which being accomplished, then a recurrence may be
had to tonics, with some reasonable prospect of success.*
Of the tonics, perhaps, the best is the subcarbonate of iron.
* It would be alien to my purpose to treat on this occasion of the modes of
correcting the various pravities of system associated with this disease. Derange-
Chapman on Tic Douloureux, 309
This article in enorpious doses, from a drachm or more, several
times a day, was some years ago introduced by Mr. Hutchinson of
England, and its utility verified by a host of practitioners. It has
since lost some credit, to be ascribed perhaps in a degree to its gene-
ral and vague employment. On what principle it acts is not exactly
determined. As a tonic merely, its effects cannot be explained, and
I am inclined to refer them to that property of lessening sensibility
which it evinces in most nervous affections.
The nitrate of silver operates seemingly in the same mode, and is
worthy of attention. Equally perhaps is the superacetate of lead
and the preparations of zinc, though I have not heard of any fair trial
of them.
The subnitrate of bismuth is not undeserving of regard, espe-
cially in the ganglionic affections. Experiments should be made also
P^. with the powder of nut-galls. Directly applied to an exposed nerve
of a tooth, it so wonderfully deadens its sensibility, that it may be
stuffed without pain, and hence it promises some advantage when
internally administered, particularly in neuralgia of the stomach.
It is to be supposed, in a case attended by such acuteness of pain,
the narcotics have not been neglected. Every one of them, on the
contrary, has been abundantly prescribed, and excepting the stramo-
nium and belladonna, the whole are now repudiated. By Marcet,
»BiGBEE, Elliotson, &c. the strongest testimony is borne to the for-
mer, and the latter is not less sustained by the reports of Bailey and
other authorities. But I have derived little advantage from either of
these, or any other of the class. Combined with quinine, their powers
appear in some instances to be improved.
Neuralgia of a decidedly intermittent type, by whatever causes in-
duced, whether malaria or other agencies, exacts those remedies
which experience teaches interrupt most certainly paroxysmal ten-
dencies. Copious as this catalogue of medicines is, I believe that
the confidence of practitioners is now mainly reposed in the Peru-
vian bark and its preparation, the sulphate of quinine, par excel-
ments of the digestive functions will be found greatly to preponderate. As a
course appropriate to a large majority of such cases, with a design especially to
the correction or restoration of secretory power, the important end to be at-
tained, I have to say, that incomparably the most effectual process, according
to my experience, is to administer a few grains of the blue pill at night, to be
worked off by a wine-glassful of the annexed mixture in the morning: — R. In-
fus. tarax. giv.— Extr. tarax. ^ij.—Carb. sods, gss.— Tart, potassse, Tinct.
rhei, aa. ^iij.
310 Chapman on Tic Douloureux,
lence,* and in those of arsenic, particularly the arsenite of potash,
which however I am sure is less active than the white oxide. The sul-
phate of copper has, perhaps, claims to attention, it having in one case
under mj care proved serviceable, where the other articles were nu-
gatory. Nor ought the oil of turpentine to escape notice. It evinces
considerable power over common intermittent habits, and we have
some evidence of its utility in neuralgia sciatica especially.
Devoted as modern practitioners are to the employment of mer-
cury, it can hardly be presumed that an extension of it has not been
made to the disease under review. The trials of it in this country
at least have been numerous, and I am afraid very discouraging.
Except for the purpose of correcting certain vitiated states of system,
generated chiefly by miasmatic influence, and here rather to its al-
terative than salivant effect, it seems to me that every other applica-
tion of it must be inapt and prejudicial. Yet there are several cases
reported as cured by a salivation. Led by some supposed analogy
in their effects to mercury, the preparations of iodine have been re-
sorted to in this disease, and with reputed success. But I confess
that I have never witnessed any benefit from them, and am disposed
to doubt altogether their efficacy.
Emetics, which we have learnt are probably useful in the paroxysm,
are, I think, certainly so in regard to the removal of the disease. It
is thirty years since I first employed them, and though they have
often disappointed me, I have sometimes derived signal advantage
from them. As they operate in the extermination of inveterate in-
termittents, so do they probably in the neuralgic affections. The
case to which, according to my experience, the practice is best fitted,
is where the pericranium becomes permanently tender with darting
pains through it.
Connected with a gouty or rheumatic habit, regard should be paid
to this consideration in the management of the case. It is under such
circumstances, I suspect, that colchicum, which has acquired much
confidence in neuralgic disturbances, is serviceable.
* This article is usually directed in too small doses, and hence probably one
cause of its frequent failures. The foreign practitioners prescribe it far more
liberally in this disease than we have generally ventured to dO' — some of them
even in prodig-ious quantities. Not less than five grains, repeated several times
a day, should be given. Combined with the dulcified spirit of nitre, and a little
laudanum, its unpleasant effects are obviated. Thus united, I have seen my
friend, Dr. Mitchell of this city, give a scruple of it at once in intermittent fever
with the happiest effect.
Chapman on Tic Douloureux. 311
It remains to mention electricity, galvanism, and magnetism.
These agencies were at one time in considerable repute, which on a
fair and more extensive trial, appears not to have been justified. Gal-
ijanism in a different mode of application, has, however, recently
been very triumphantly directed by my friend Dr. Harris, in three
cases of the disease. The mode is that recommended by Mansford,
in epilepsy.* But here too, disappointments have been more fre-
* " It was said, that in order to fulfil the indication stated at the commence-
ment of this section, it was desirable to establish a negative point as near the
brain as possible, and a positive one in some distant part of the body, (a) Ac-
cordingly, a portion of the cuticle of the size of a sixpence being removed by means
of a small blister on the back of the neck, as close to the root of the hair as possible,
and a similar portion in the hollow beneath, and on the inside of the knee, as
the most convenient place: to the wound in the neck, a plate of silver, vary-
ing according to the age of the patient, from the size of a sixpence to that of a
half-crown, was applied — having affixed to its back part a handle or shank, and
to its lower edge, and parallel with the shank, a small staple, to which the con-
ducting wire was fastened. This wire descended the back till it reached
a belt of chamois leather, buttoned round the waist — it then followed the
course of the belt, to which it was attached, till it arrived opposite the groin on
the side it was wished to be used; it then passed down the inside of the thigh,
and was fastened to the zinc plate in the same manner as to the silver one. The
apparatus so contrived was thus applied: — a small bit of sponge moistened in
water, and corresponding in size to the aperture in the neck, was first placed
directly upon it — over this a larger piece of sponge of the same size as the me-
tallic plate, also wetted, was laid — and next to this the plate itself, which was
secured in its situation by a strip of adhesive plaster passed through the shank
on its back, another above, and another below it. If these be properly placed,
and the wire which passes down the back be allowed sufficient room that it may
not drag, the plate will not be moved from its position by any ordinary motion
of the body. The zinc plate was fastened in the same manner — but in place of
the second layer of sponge, a bit of muscle answering in size to the zinc plate
was interposed: that is, a small bit of moistened sponge being first fitted to the
aperture below the knee, the piece of muscle (6) also wetted then followed, and
on this the plate of zinc. The apparatus thus arranged will continue in gentle
and uninterrupted action from twelve to twenty-four hours, according to cir-
cumstances. This last is the longest period that it can be allowed to go unremov-
ed: the sores require cleaning and dressing, and the surface of the zinc becomes
covered with a thick oxide, which must be removed to restore its freedom of
action; this may be done by scraping or polishing: but it will be better if re-
moved twice a day, both for the greater security of a permanent action, and for
the additional comfort of the patient." — Mansford on Epilepsy.
(a) The hypothesis from which this practical expedient is deduced, supposes an undue accumula-
tion of electric matter in the brain, at the expense of other parts of the body, and hence the cure
depends on equalizing the distribution of it.— N. C.
(6) Either a piece of soft buckskin or parchment is equally eiFectual, and less oifensive than the mus-
cle.-N. C.
312 Chapman o?z Tic Douloureux.
quentlj experienced, as indeed was to be expected from the diversi-
ties of the disease. He tells me that it has only proved eflectual in
the affections of the face.
As enumerated, such are the remedies in neuralgia, which in va-
rious degrees, retain the confidence of practitioners. Mj aim in the
preceding therapeutic discussion, has been to make as just and discri-
minative an appropriation of them to the several forms and conditions
of the disease as I could accomplish. It is not however to be under-
stood that this distribution of them is absolute or exclusive. The ge-
neral condition being favourable, several of the tonics especially are
suited to a wider application than given to them bj me, and I have
reason to think, that in some instances, the sulphate of quinine and
the carbonate of iron united, are more effectual than either article
separately. But every thing connected with the disease is so obscure —
its causes, its seat, the precise pathological state in its several
modifications, that I am sensible I have not been very successful in
the attempt. Nor do I believe, at present, it can be done. To a
certain extent we may be governed by principle in the treatment, or
in other words, having carefully studied the case, adapt the means
with exactness to the views adopted of it. But in other instances when
dark and involved, we shall be forced to depart from this order, and
plunge into the devious path of empiricism, which I have endeavour-
ed to avoid, prescribing vaguely or without any rational guide.
With a few remarks on regimen, I shall close this disquisition. To
diet not much importance has been attached. But varied as are the
forms of the disease, and the state of the system with which it is as-
sociated, surely some discrimination is demanded. Generally speak-
ing, nutritious animal food of light and easy digestion answers best,
and is indispensable in feeble and exhausted conditions, especially
should depravation of the stomach and subsidiary organs exist. On
the contrary, cases of a different character are presented, where to a
full and phlogistic diathesis, there is united the highest possible
degree of local irritation, as is strikingly exemplified in many of the
spinal affections. Common sense here dictates a considerable reduc-
tion in the course of living.
The same accommodation to circumstances is to be observed in other
respects. Exercise, or even a journey operating in part by a change
of air and certain moral influences, is highly beneficial in many in-
stances, while in others, aggravated as they must be by motion, it is
altogether precluded. There is a maxim of universal application.
Let the regimen be such, as shall harmoniously cooperate with the
general plan of treatment.
Chapman on Tic Douloureux. 313
Connected as this disease commonly is, with constitutional dis-
turbance, there is forced upon us the value of regimen, and some
other analogous means of cure, among which is a resort to our mi-
neral springs, and particularly to the thermal waters of Virginia.
Miraculous almost in the relief they aftbrd to arthritic, rheumatic,
and the affections generally having a resemblance to neuralgia, it
is presumable that they would also act favourably in it.* Combined
with a bath of unequalled excellence, they offer the perfection of cli-
mate as regards alike comfort and salubrity, with every social advan-
tage, elegance of entertainment, and delightful recreation for body and
mind. These are strong recommendatory considerations, not heed-
lessly to be disregarded.
Annexed will be found some cases, selected out of a large number
"which have come under my own observation, as the best adapted to
illustrate the mode of origin, and treatment of the neuralgic affec-
tions.
Cases dependent on irritation of the teeth. — Case I. In 1815 I was
consulted by a lady in this city, who for the several preceding years
had suffered excruciating agony in her face — at first at distant inter-
Lvals, gradually becoming more continued. Convinced of the neural-
*gic nature of the case, as well by the character of the pain, as the
total absence of inflammation in the attacks, and suspecting a tooth
to be in fault, I had her teeth repeatedly examined by a skilful den-
tist, without, however, his detecting the slightest defect, or even any
increased sensibility in any of them — the whole appearing, on the con-
trary, remarkably sound and beautiful. But finally, on chewing a
crust of bread, one of the cuspidati was broken off, exhibiting an en-
rtire decay, with the exception of the enamel, which was perfect.
The stump being extracted, from that moment she experienced not
the slightest uneasiness of the kind.
Case II. Not long afterwards, a lady from Virginia, who had been
ifflicted for a lengthened period in the same way, came under the
;are of Dr. Physick and myself. Though she could never trace the
fpain of the face to her teeth, perceiving two of the front ones nearly
^destroyed, we had the roots taken out, and a permanent cure ensued.
* What has been thus advanced conjecturally, I find, by a recent publication,
is confirmed as to the decided efficacy of similar baths on the continent of
Europe. To bathing may also be added the use oi douches ^ by which is meant
the projection of water on the affected part, from a height through tubes of
various calibres.
No. XXVIII.— August, 1834. 27
314 Chapman on Tic Douloureux.
Case III. More recently, a lawyer from Maryland consulted me
for a similar affection, by whom I was informed that for upwards of
three years his agony had been so frequent and intolerable, that he
was forced to abandon his profession and all other business. Except-
ing an eye-tooth, the root of which only remained, the rest were in
the finest condition — to the extraction of which fragment, he at first
objected, as it had never given him any inconvenience — but labouring
under an attack at the time, he speedily consented to its removal,
and the operation was productive of entire success.*
Cases proceeding from diseased vertebrae. — Case I. My attention
was first awakened to this view of the origin of neuralgia by the
case of a boy, whom I was attending for an enlargement of one of the
dorsal vertebra. Each day, precisely at noon, for more than two
weeks, he was attacked with violent, acute, lancinating pain of the
true neuralgic kind, through his bowels, continuing for several hours,
without any mitigation from remedies the best calculated to relieve
the affection, had it been primarily seated in the intestinal tube, or
of the nature of colic. Baffled in this way, it at length occurred to
ine, that all this suffering might be owing to spinal irritation, and
acting under such a conviction, a treatment, consisting of an appli-
cation of leeches, &c. was instituted with the happiest result. As
confirmatory of the accuracy of my estimate of the case, it should be
mentioned, that several times during the protracted confinement of
the boy, whenever indeed any exasperated spinal irritation took
place, manifested by an increased tenderness of the diseased verte-
bra, there was a return of the same sort of intestinal pain, and as
readily submissive to similar means.
Case II. During the present year, I attended in consultation a
young lady, who, for several months previously, with the most indo-
mitable constipation of bowels 1 have ever known, had constant acute,
lancinating pains through the chest, in the direction chiefly of the
intercostal muscles, extending occasionally to the head. On exami-
nation, two of the dorsal vertebrse betrayed considerable tenderness,
without, however, the slightest protuberance or appearance of in-
flammation at these points. The case was, therefore, deemed one of
simple spinal irritation, in which both the nerves of sensation and
* It is a curious fact, that in all the cases of dental neuralgia which I have
seen, the tooth itself supplying the irritation evinced no increased sensibility.
Nor have I ever seen the disease connected with the molares.
Chapman on Tie Douloureux. 315
motion were concerned. By rest in bed, frequent leeching, and
moxa issues,* she so far recovered as to lose all pain, and with such
an amelioration of the state of the bowels, that they were readily
opened by the mildest enemata. Continuing progressively to im-
prove for some weeks, she then unfortunately quitted the recumbent
posture, and engaged in too active exertions, from which a relapse
ensued with marked aggravation. The vertebrae now were found
enlarged and thickened, and in addition to the former affections,
a partial paralysis of one of the lower extremities had taken
place.
Case III. But the most interesting instance I shall now relate, that
of a lady from Georgia. Becoming my patient, she told me, that for
several years she had been afflicted with pains in nearly every part of
her body, and so exquisitely poignant, as scarcely to be endured, and
that she had sought relief to no advantage from some of the ablest
physicians at home and in Europe. My attendance was very short
before I discovered her deplorable condition. By day and by
night was she tortured by neuralgic pains in the head, as clavus hys-
tericus, or in the chest, by rapid and repeated dartings through the
lungs or heart, or diaphragm, attended with such embarrassed respi-
ration, as not to admit of the recumbent position^ — or at other times
entering the abdomen, affecting in a like manner successively the
contents of that cavity, or leaving the interior, fixing, for a while, on
the lower extremities. As a harpey, had the disease thus preyed
upon her, and she was wan, haggard, and emaciated, with great irri-
tability of stomach, loss of appetite, and weakened and vitiated di-
gestion.
Different notions had been entertained of the case by her medical
advisers — some considering it as dyspepsia, and others as chronic he-
patitis, or rheumatism, or gout, or angina pectoris, prolapsus of the
uterus, &c. according to the predominance of the symptoms at the
* The common practice of establishing issues immediately on each side of
the affected vertebra is bad. They should be placed some inches from it, and
the same remark applies to leeching". Being" near to, or in contact with it, in-
stead of operating as divellents or counter-irritants, they may have a contrary
effect, exacerbating the irritation of the spinal marrow: but especially the in-
tensity of inflammation, which is so apt to follow caustic issues, should be avoid-
ed. By this circumstance alone, I have, in more than one instance, seen neural-
gic pain, and the paralytic state, conspicuously increased, and each again re-
lieved, on the reduction of the inflammation, by emollient poultices, &c. Moxa
issues are greatly to be preferred to those produced by any other means. They
are less painful, more manageable, and decidedly of superior efficacya
316 Chapman on Tic Douloureux,
time. But on my very first visit, I was satisfied that such a train of
phenomena couhl only be referred to spinal irritation, in which im-
pression I was confirmed by the detection of an enlargement of the
last of the dorsal vertebra, with tenderness on pressure of the spinal
column to some extent. By confinement to her bed, and mea-
sures mainly addressed to the local affection, cupping, leeching, and
blistering, sufficient alleviation was early procured to encourage a
persistence in them, and at the expiration of several months, not a
vestige of the disease remained.
Cases ivithout such obvious lesions of the spine. — Case I. Three
years ago, a middle aged man called on me for my advice in relation
to an inveterate neuralgia of the face, shooting in various directions
from the ear through the jaw^s, up to the top of one side of the head —
for the cure of which, much in vain had been previously done, and
among other unavailing means tried, was the extraction of several
teeth. By percussion and pressure a very great degree of sensibility
was revealed about the first of the cervical vertebrae, followed in-
stantly by darting pains in the courses already mentioned. No doubt
could longer be entertained of the primary seat, or of the nature of
the affection, and by repeated leechings around the tender point, and
moxa issues over the mastoid processes of the temporal bone, he ul-
timately got well.
Case II. Nearly about the same period I was called to a very
young lady from the south, who had been previously attended by
another physician for several months. It appeared from the history
of the case, that she had led a gay and fashionable life during the pre-
ceding winter in a neighbouring city, by which her general health had
become extremely impaired. The earliest symptoms were those of
anorexia, irritable stomach, defective digestion, and costiveness, with
head-ache, acute pain in the direction of the intercostals, and above
all palpitations of the heart, shortness of breathing, and a sensation
as she expressed it, "of sinking or giving way" in the epigastric
region. By the time I saw her, these symptoms had reached an ex-
asperated state, and there were added to them, the alternation of
menorrhagia, and leucorrhoea to excess, with weakness of the loins,
and unremitting dull ache in the lumbar portion of the spine, attend-
ed by a bloated, exsanguineous aspect. Learning that she had been
in the habit of lacing her corsets very tightly, I at once suspected
that this was the primary cause of all the mischief, having seen it pro-
duce the same effect in some other instances, by an injury of the
Chapman on Tic Douloureux. 317
spine. Tenderness in two-thirds of the dorsal section of the vertebra
was discovered.
As the loss of blood seeming inadmissible in such a leucophlegmatic
condition, I substituted a repetition of dry cupping and blisters over the
sensitive part, gave a small quantity of the blue pill at night, and the
taraxacum mixture in the morning to promote the secretions, which
end having been attained, she was put on the use of the phosphate of
iron, united to a small portion of aloes to keep the bowels open. These
remedies, with a state of rest, and a nutritious diet carefully regulat-
ed, by degrees so far abated the topical affection, and restored her
general health as to enable her to go to the country, where, using
moderate exercise, she entirely recovered.
Case III. Last spring I saw a married lady from the country, who
had come to consult me for what was apprehended to be the commence-
ment of a cancerous affection of the left mamma. During the winter
she had felt much soreness in it, with sharp, darting pains through it into
the axilla, down the arm, which was also slightly numbed, occasion-
ally extending upwards so as to involve chiefly the pericranium. The
case had been thought to be rheumatism, and was treated by leech-
ing, blistering, fomentations, to the breast itself, and by enveloping it
in fur. These measures having failed, the more alarming view men-
tioned was taken of it, and in this state of mind she applied to me.
Excepting great tenderness, 1 could perceive nothing abnormal in the
breast. It was soft. Without any tumour, or even the slightest change
in the lymphatics. But on pressure it proved to be very sensitive,
and a manifest increase of the shooting pains instantly followed.
Though no appreciable degree of sensibility was evinced in any part
of the spine, I so strongly suspected the whole affection to proceed
from irritation of the cervical portion of it, that I determined to treat
the case under such a view. Encouraged by the success of a single
leeching and a blister to the neck, these were repeated several times,
when all the symptoms had so much subsided that I permitted her to
return home, and not hearing from her since, I presume they totally
disappeared.
Cases of ganglionic irritation. — As remarked on a former occasion,
such is the tendency of the different classes of nerves, and especially
the spinal and ganglionic, to participate in each others sufferings, that
instances of neuralgia of a distinct and independent existence in any
of them, are seldom to be met with. Most of the preceding cases af-
ford illustrations of this complication. The reverse, however, does
27*
318 Chapman on Tic Douloureux,
sometimes happen, and perhaps the following may be deemed exam-
ples of a separate and exclusive lesion of the ganglionic nerves.
Case I. An elderly gentleman from Louisiana, came hither in 1828
to consult me about his health. The account which he gave of his
case, was that though he resided in a miasmatic district of country,
he had entirely escaped intermittent and other autumnal fevers which
for several seasons had there been generally prevalent. But in place
of these, two years before, he was suddenly seized without any ob-
vious cause, with cramps of the stomach, which returned daily, and
then every third day exactly as to the hour for several weeks. To
these spasmodic affections succeeded darting, poignant pains through
the hypochondria, in the region of the kidneys, and of the bladder —
sometimes in the one, and at other times pervading more or less the
whole, the disease gradually losing the character of periodicity, so
that the attacks reverted very irregularly. The case had perplexed
various physicians exceedingly, having been considered as gout,
chronic hepatitis, nephritis calculosa, stricture of the urethra, &c.
Being satisfied on a careful perquisition, that these conjectures were
incorrect, I inclined to believe that the case was of a neuralgic nature,
originating in miasmatic influence, and the more so from having seen
during the prevalence of epidemic intermittent fever among us, which
abounded in anomalies of all sorts, not a few similar instances. No
tenderness, however, could I detect in any part of the spine, nor
were there any symptoms referable to that source of irritation.
Correcting the disorder of the chylopoietic viscera, which was con-
spicuous, by an alterative course of the blue pill, and the occasional
interposition of a purge, 1 then administered largely the sulphate of
quinine alone, and with the piperine. These remedies were useful,
though not decisive, and 1 next resorted to the sulphate of copper,
which completely put an end to every affection.
Case II. Not two months ago, a gentleman from the interior of
this state, called on me for my advice, who had the aspect of even
robust health. He was muscular, florid, and apparently with entire
integrity of constitution — but he complained of having for a considera-
ble length of time suffered severely once or twice a week by spasms
of the stomach and bowels, with occasional darting pains throughout
his abdomen. These were the only symptoms mentioned, and I
found on witnessing several attacks, that be had accurately stated
his case. No reason existed to suspect gout — his digestion was good,
the bowels sufficiently open, and the evacuations natural in quantity,
colour, and consistency. The case struck me as compounded of
Chapman on Tic Douloureux. 319
gastrodynia and entered jnia, or a painful irritation confined to the
ganglionic nerves expanded over the surface of the alimentary canal.
His spine betrayed no tenderness, and he never referred any of his
sufferings to that part. Before I saw him, he had been treated by
general and local bleedings, by counter-irritants to the epigastrium,
and by opiates and various antispasmodics, without however any per-
manent benefit. As his circulation was active, with some tenderness
over a greater portion of the abdomen, I took from him by venesec-
tion and repeated applications of leeches to the tender part, as well
as to the spine, about sixty ounces of blood. Though the force of
vascular action was sensibly reduced by this depletion, there was no
mitigation of the tenderness or other improvement. The attacks, in-
deed, recurred oftener and more violently. After an ineffectual
trial of several remedies, I directed the sub-nitrate of bismuth and
opium united, which for a time seemed to answer well: but ultimately
ceasing to do good, these articles were discontinued, and in place of
them, ten grains of the sub-carbonate of iron were taken every fourth
hour. His cure henceforward rapidly advanced, and in three weeks
I dismissed him well.
In dismissing this case, I cannot forbear to remark, that the Martial
preparations, and especially the sub-carbonate of iron, I have found
chiefly serviceable in the neuralgic disturbances of the stomach and
bowels. I shall add only one other case, to show the connexion be-
tween the disease and arthritic irritation.
Early last spring, a gentleman beyond the meridian of life, of very
gouty habits, was suddenly attacked with the most excruciating pain
mainly in the direction of the frontal sinuses. But it occasionally ex-
tended to the side of the face, and even to the scalp, sweeping some-
times around the ear, and darting also, into the eye. The paroxysms
uniformly occurred about 4 o'clock in the morning, lasting on an aver-
age two hours each attack, and then gradually abated, till an entire sub-
sidence took place. General and local bleedings, vesications, opiates,
and other narcotics, administered internally, and endermically ap-
plied, were of little service. From the paroxysmal nature of the af-
fection, and the absence of fever, I resolved to try the tonics, and
accordingly, the sulphate of quinine, the arseniate of potash, and the
sulphate of copper, separately and united, were freely given, and for
a time with some advantage: but they soon lost their efficacy, and
the disease becoming still more afflicting, the whole of these reme-
dies were abandoned. It now happily occurred to me to use the tinct-
ture of colchicum, and as a purgative at the moment was required, I
320 Chapman on Tic Douloureux,
prescribed it in combination with calcined magnesia and the sulphate of
magnesia. Much relief was afforded on the operation of the mixture,
and bj continuing the colchicum itself in such doses as to keep the
bowels well opened, he very rapidly recovered. Though subsequent-
ly he has had several admonitions of a repetition of the disease in the
same part, a recurrence to this medicine has uniformly obviated an
attack, and it may deserve to be noticed, that during this period
there has been a greater exemption from gout, and the enjoyment of
better health than for many preceding years.
Most of the cases I have recited, it appears, were treated success-
fully. Let it not, however, be supposed that I mean to vaunt of my
pretensions to any superiority of skill in the management of this dis-
ease. It were easy for me to present numerous instances of it in
which all my efforts were baffled, and where the mortification was
felt of surrendering up the patient without having mitigated his dis-
tress in the slightest degree. The fact is, that recent neuralgic affec-
tions occurring in a sound constitution, and especially when originat-
ing in spinal irritation, of which character was a large proportion of
the cases I have adduced, will prove tractable to a practice regulated
by judgment and discrimination. But very much reverse does expe-
rience teach is the result in relation to such as arise from certain
causes, or are connected with particular lesions, or with depravation of
the system, or have become inveterately fixed by duration only. Chronic
degenerations, under all circumstances of disease, are difficult of re-
moval, and as to the neuralgic affections, in this state, my own endea-
vours have so often failed, that I am prepared to pronounce them al-
most insuperable. My only object in the publication of these cases,
is to lay before the profession a series of facts concerning a disease
of extensive prevalence among us, deeming them calculated as well
to shed some light on its nature and treatment, as to encourage others
to investigations and discoveries to overcome this, one of the most
excruciating maladies which afflicts mankind. That they are imper-
fectly related, I am aware: but having designed them merely as illus-
trations of a lecture on the subject of neuralgia, an occasion where
minuteness of statement is to be avoided, I have preserved only sum-
maries, and it were vain now to attempt to supply deficiencies by
an appeal to my memory for accurate details after such a lapse of
time.
feb:
1:
Miller's Baltimore Alms-house Reports, 321
Art. II. Reports of Cases treated in the Baltimore Jilms-house In-
firmary. Bj James Henry Miller, M. D. Physician to the Insti-
tution.
W IDE as the field of science has been expanded by the number of
recent discoveries and the extent of modern improvements, still it is
but too justly alleged that they have availed very little in practical
utility. Physiology has been highly endowed by contributions from
the collateral sciences, yet pathology cannot boast a comparative
amount of acquisition. The former has placed many of the agents of
nature under requisition, and derived from their aid much valuable
aid, whilst the latter has stood in idle astonishment and profited no-
thing from observation.
A considerable period has already elapsed since galvanism has
been made to arouse dead muscle into action through the intermedia-
tion of the nerves, and even yet application of this power has been
made towards the restoration of fibres that are only diseased. The
world generally is acquainted with the startling phenomena afforded by
the infusion of this fluid into animal structures, and is eager in its in-
quires why we do not employ it to remove some of the opprobia that
still disgrace our practice. We are upbraided for our remissness in
prose, and satyrized in poetry for our culpable inertia.
***** Galvanism has set some cases grinning.
But has not answered like the apparatus
Of the Humane Society's beginning"
By which men are unsuffocated gratis.
It being admitted that this modification of electricity is capable of
substituting in some manner and measure that principle, whatever it
is, which ordinarily acts through the nerves, it is legitimately infera-
ble that it may be converted into a most energetic therapeutic agent.
That it has not insinuated itself into general practice, is probably owing
art to the obstacles always set up before every new article, and also
from the timidity, arising from a knowledge of its potency, which
deters from its employment. Prudence in the use of any new and
especially a very active agent of the materia medica is unquestion-
ably commendable; however, whilst temerity is to be deprecated, as-
suredly that timidity which would refrain from rational experiment
when opportunity is presented, and when neither risk or injury is
jto be hazarded, and where beneficial results are confidently to be hoped,
s not only despicable but highly criminal against the best interests of
umanity.
322 Miller's Baltimore Alms-house Reports.
Public receptacles of the sick yield advantages, facilities and pri-
vileges, to innovate and improve remediate means unenjoyed in pri-
vate practice, and it is undoubtedly the duty of the medical officers
of these institutions to cultivate the resources of science, and offer
the fruits to the acceptance of the profession. With these impressions
the following cases are presented, and also in the hope that they may
perchance emit some additional light upon the qualities of this new
article of the materia medica, or perhaps suggest some slight clue to
unravel the still bewildered pathology of one of the most distressing
of our nervous affections.
Case I. Paraplegia. — Michael Mullen, an Irishman, twenty-six
years of age, was admitted, June ISth, 1833, with paraplegia. He
says that until about a year since, when he was attacked with fever
and ague and the subsequent paralysis, his health had always been
goodj that his athletic powers had uniformly been adequate to the pro-
curement of his subsistence by hard labour; and that since his arrival in
this country he had been chiefly employed upon our roads, canals,
and other public works, where he received full wages as an able-
bodied hand. He is very pale, and although of the sanguine predis-
position, his countenance exhibits the blank expression of want of
hope; he is greatly emaciated, suffers occasional returns of chills and
fever, and in the intervals his temperature, and especially of the lower
extremities is below par; his appetite is precarious; bowels torpid;
tongue small, sharp, and slightly furred; pulse frequent, small, and
weak. There is a considerable distortion of the spine, presenting the
appearance of a well-defined tumour of three inches diameter at th^
base and about one inch and a half in height with a scale on the
apex. From this tumour there is no discharge of pus, sanies or other
fluid. Its location is at and over the fifth and sixth dorsal vertebrae.
He is incapable of giving any account of the origin of his hunch,
"for," says he, "it has been there ever since I can remember, and
long before, and may be was born with me." He avers that it never
occasioned him any pain or other inconvenience, until during his
confinement by the fever last year, when for the first time he began
to experience soreness and pain in the part, but which was at the
time attributed to the erosion and inflammation arising from his posi-
tion in bed and the undue amount of friction made upon it as the
most prominent part. With the progress of the ulceration of the
hunch he perceived a gradual diminution of sensibility and motion of
the lower extremities until it terminated in an entire loss of both
sensation and motion. The paralysis is now so complete that he can
feel neither pinching, puncturing, cauterization, or any other stimu-
Miller's Baltimore Mms-house Reports. 323
lating contact; nor can he bj the utmost effort of volition contract
a single fibre of any muscle of the lower extremities. He distinctly
recollects that during the subsidence of the powers of his infe-
rior half, he occasionally suffered pains of various and indescribable
kinds in his back, sides, hips, thighs, &c. and although much less
frequent and intense, they still torment him in the pubic and iliac
regions, and also along the upper part of the spine. Doubtless, a
portion of this suffering is attributable to the condition of the bowels,
because it is always greatest where they are constipated.
His rectum and bladder still acknowledge their alliance to the
dominion of his will.
It does not appear that his alimentary tube and its collatitious viscera
have sustained any impairable injury, although they are all evidently
indolent, and require occasionally to be urged to duty. The fever,
a tertian intermittent, has never been subdued, and seems merely to
acquiesce in a reluctant truce.
We are unable to extract from him any satisfactory information as
to the treatment which he has undergone. Almost the only things
of which he declares he is very certain, is, that he has taken a great
deal of mercury; has been salivated more than once; has taken a great
deal of Queen Ann, (quinine;) has been repeatedly blistered; *' and
swallowed a heap of doctor-stuff more."
Our attention was first directed to the removal of the intermittent,
which was readily accomplished by obviating the torpor of the vis-
cera, interrupting the habits of the disease, and corroborating the as-
similating apparatus. All this was effected by the ordinary means in
about a fortnight. Having reestablished order amongst the nutrient
organs, we next began to institute efforts to repair the locomotive ma-
chinery.
Believing the paraplegia to have arisen from an inflexion of the
spinal cord from its ordinary line of direction, by alteration of
structure resulting from the fever, and also in part from the long
continued pressure of the body upon the more protruded portion, by
which a permanent compression on the medulla spinalis had destroy-
ed the function of the lower part, and consequently the nerves pas-
sing off from it to the inferior extremities: therefore to obviate this me-
chanical cause of the disease, he was placed upon an inclined plane,
so adjusted as to support the upper half of the body, and allow the
lower parts to be freely suspended by their own weight. This position
was soon found to afford him very great but undefinable relief. He
seemed solicitous to express the kind of benefit derived from this
324 Miller's Baltimore Alms-house Reports.
new situation, but failed in words to communicate his ideas. It was
not a relief from pain, because the parts were incapable of suffering;
nor was it a restoration to pleasurable sensation, because thej still
remained insensible; but it was a feeling of liberation from confine-
ment without the power of exerting or enjoying liberty; a satisfied
freedom from constraint without the disposition to action.
Free as the nerves now evidently were, they continued inert.
Hoping to stimulate them to a resumption of official acts, various
plans were instituted, and nearly every proposed remedy was tried,
yet all were unavailing, except so far as that under these varied pre-
scriptions; regard was had to the preservation and perfection of his
general health, which continued improving, and the ulcer upon the
apex of the curve of the spine cicatrized pretty firmly.
Having exhausted all the ordinary resources of art, and still
believing that if by any agency the nervous power could be reinstated
or determined to flow in its former channels, locomotive life might
be restored to the paralysed limbs, and knowing the effects produced
by galvanism in many physiological experiments, and that it had
been suggested as a remedy in affections of this kind, we prepared
for its administration.
September 6th. Having during the night procured vesication to the
desired extent upon the back of the neck and on one of his legs, the gal-
vanic apparatus was applied.
The mode of application although not new, may not perhaps be
familiar to all. It is this: remove a portion of cuticle by means of a
blister from two portions of the body on which it is designed to act,
sufficiently large to afford a basis on which to place the piles; these
are composed of a flat piece of sponge, an equal portion of fresh
muscle, of beef, mutton, pork or other butcher meat, and the metallic
plates, one made of silver and the other of zinc. These plates are
elliptical, the ordinary diameter about two inches, the conjugate about
one and a half, they are made button fashion with an eye in the
centre, for the convenience of attaching the connecting silver wire.
On the denuded surface place the sponge saturated wifh a solution of
common salt in water, over the sponge place the layer of muscle,
and upon the muscle place the plate, into the eye of the plate fasten
one end of the wire, then confine the whole firmly upon the part by
bandages or adhesive strips. The silver plate is to be placed nearest
to the origin, and the zinc one at the termination of the nerve.
In a very few minutes after the adjustmentof the apparatus, we were
gratified with the observation of a remarkable alteration in the state
Miller's Baltimore Alms-house Reports. 325
of the circulation, and the temperature of the paralysed limbs. The
pulse which had fluctuated between 96 and 112, became pretty
stationary at about 88.
The temperature which previously had been as low as 62° of Fah-
renheit's thermometer, in a very brief space of time arose to 89° At
first the galvanic apparatus was applied and retained two or three
times a day, and for only half an hour at a time. Finding that
the temperature, circulation, and general sensations were always
greatly improved during the application, and that in the intervals
some portion of the good effects were lost, it was afterwards kept in
pretty continuous operation. In a few days we were cheered by a
very obvious amendment, his sensibility in the hitherto insensible
parts began to dawn, and the mobility, although very slight at first,
soon became very obviously perceptible.
18/A. Galvanism continued^ alternately shifting the zinc pole from
leg to leg. The strength, especially about the loins, is decidedly in-
creased, insomuch that he is able to aid in the change of position.
It may not be unworthy of note, that shortly after the resort to gal-
vanism, and after the patient began to give utterance to reviving hope
of recovery, to determine how much of his improvement might be at-
tributed to his faith in the novel expedient, and how much might right-
fully be accredited to the galvanic fluid, we inverted the poles, with-
out the patient's knowledge, when he immediately began to respire
with great anxiety, and complain of an inversion of all his bowels
threatening suffocation, or as he expressed it, "a rising up from the
bottom of his belly into his throat, and bringing on a sickness of
heart." He became very importunate to have the plates removed,
as they gave him a great deal of a new kind of pain, and declared
that they had never before effected him thus, and that if they were
not instantly taken off they would kill him. Fearful of carrying the
experiment too far, yet without any intimation to him, they were re-
stored to their former situations, when he instantly desisted from his
complaints, and stated that every thing was right again.
23J. Owing to the absence of the student who had the especial
care of this case, for three days past the galvanism has been discon-
tinued, and the patient has evidently retrograded. He now complains
of coldness of the legs, general uneasiness, and loss of appetite. Re-
new the blisters, and then reapply the plates as heretofore.
26^A. Is again better.
28^A. The heat of his limbs has been gradually increasing since
the last application, and is again at 89°, which seems to be the maxi-
No. XXVIIL— August, 1834. 28
326 Miller's Baltimore Alms-house Reports.
mum point. His strength is also returning, and is nearly equal to
what it was before the discontinuance of the galvanism.
October Ist. — The plates are retained on day and night, with the
most obvious advantage in every respect.
%th. The plates have been kept on constantly, except the short pe-
riods requisite for refitting. The mobility of the limbs has so much
increased that he can throw them about with great ease.
22c?. The recent atmospheric vicissitudes have induced a catarrh,
from which he suffers considerably. He has pain in the side, stitches
in the breast, and great soreness of trachea in respiration. R. Sulph.
magnes. 5iss., Antim. tart. gr. iij., Aq. pur. §viij. M. c. coch. j.
o. h. ss. donee, alv. resp.
23d In the morning no better; but after the medicine had operated
freely, he was much relieved. In the evening there were symptoms
of considerable irritability. R. P. Ipecac, comp., Prot. chlor. hy-
drarg. aa. gr. x. M. c. h. s.
24^/«. He rested well, but the medicine not acting upon the bowels,
he experiences tenderness of gums. R. 01. ricini, 5iss.
9.5th. The oil did not act well. The pain however is removed, and
he breathes freely. His only complaint is soreness of mouth.
26^^. Mouth a little better: no pain. There still exists some irre-
gularity in the bowels, for which he was ordered the Pulv. ipecac,
comp. gr. x., which fully answered the indication. The galvanism
has been discontinued since the 21st, but is now resumed.
30^/i. Mouth is now nearly well. His limbs are growing much
stronger, and his improvement in every way is rapid, and especially
so, as he declares, since his sore mouth began.
November 8th. — Since the last date he has been trusted alone to
the inclined plane, and the tonic powers of a cold infusion of chamo-
mile and quassia.
22f?. In consequence of a sensation of rigidity in the gluteal mus-
cles, he has been ordered the warm hip-bath. During the months of
December and January he was permitted to walk the apartment as
much as his strength would enable, and in every respect to deport
himself at discretion.
February 1st. — It is not yet thought proper to discharge him from
the hospital, lest the inclemency of the season should be too severe
for his recently regained powers; hence he is tolerated as an invalid
at large.
March 1st. — He continues an inmate of the hospital, but is so well
as to require no further medical attention, and it is hoped that on the
Miller's Baltimore Alms-house Beports. 327
return of the genial season he will be able to resume his usual avo-
cation.
Case II. General paralysis.'^The next case was that of Anthony
Simmons, a black boy, about sixteen years old, an apprentice to a
barber, who was admitted with general paralysis of several months
duration. His master informs us that he had been originally a very
healthy and athletic lad, and that he is ignorant of any cause to
which his disease is attributable; that it came upon him very gra-
dually; that it excited little attention until he became unable to
walk, when he was placed undei the direction of his family physi-
cian, who pursued various plans of treatment until he expressed the
opinion that the case was incurable. Determining to give him every
chance for recovery that medicine could afford, he removed him to
one of our public infirmaries, where he remained until advised to re-
move him to the Alms-house, to be supported at public charge until
death should invade every portion of his frame.
Notwithstanding his utter helplessness, his mind is apparently
sound, and his disposition even cheerful. He retains the command
over the muscles of the face and neck, and can occasionally produce
some slight movements of a few of the muscles of the left arm. His
sensibility is not impaired, but rather perhaps increased. His bowels
are obstinately torpid. His circulation is very irregular, and the
pulse intermits after every second or third beat. An epispastic was
applied to the nape, and his bowels stimulated into activity by re-
iterated portions of Epsom salt, and other of more ordinary cathartics.
In a few days he exhibited evident symptoms of amendment. His
pulse became more natural, and some mobility returned to his limbs.
In this condition he continued stationary for a time, when finding
that he could not be made to progress by any of the older remedies,
and encouraged by the experience gained in the former case, we de-
termined to have resort to the galvanic process. Accordingly, on the
11th of December, the apparatus was adjusted to his neck and one leg.
14f,h. After a lapse of only three days he is so much benefited that
he is able to set erect in the bed, and when taken out, and placed
upon his feet, can stand alone.
23c?. He continues to increase in strength and mobility. There
still existing a great tendency to constipation, occasional aperients
are from time to time exhibited, but without interrupting the galvanic
process.
9,Sth. He is so far recovered that he is regaining confidence in his
own powers, and has asked for crutches to aid him in hobbling about
the room. Treatment continued.
328 Gerhard on Pneumonia of Children.
January 1st, 1834. — Improvement gradually and rapidly ad-
vancing.
15th, So well that the treatment is discontinued.
February. — Has been reclaimed bj his master, and has gone
home.
Some days after his return to his master's shop, I called to see
him. He approached me with a firm step, made his obeisance grace-
fully, grinned a pleasant display of the ivory palisadoes, and begged
that *'Tony should hab the honour of shaving Massy Docy."
We have a case of hemiplegia now under treatment, which pro-
mises a like successful termination.
These are all the cases of palsy in which this remedy has yet been
tried by us. We are also experimenting with it in some other cases,
whose results shall be communicated whatever they may be, and pos-
sibly we may then tax your patience with some speculative attempts
at reducing our facts into the order of theory.
Art. III. On the Pneumonia of Children. By W. W. Gerhard, M.D.
of Philadelphia. [Part 1st.]
W ITH the progress of pathology the questions to be solved in-
crease in number, and each solution of a problem discovers new
groups of facts and opens new points of view, from which well-
authenticated phenomena are to be examined. As each disease be-
comes a subject of investigation, and the diagnosis and natural his-
tory of it are thoroughly elucidated, it is necessary to examine the
peculiar forms of the affection as modified by climate, age, sex, and
above all, by therapeutic means.
Pneumonia is perhaps one of the diseases the best understood; we
know with nearly absolute precision its pathognomonic characters,
its ordinary duration, the portion of the lung most frequently in-
vaded; and to a certain extent, the value of treatment in the cure, or
alleviation of the aiFection is well established. What we least know
is the modifications presented by pneumonia when the disease attacks
individuals who have not yet attained the adult age, which is selected
as most appropriate to furnish the types of disease. We now know,
it is true, that pneumonia is not uncommon amongst children, that it
is not unfrequently fatal; and still further, that few persons die below
the age of puberty without presenting a partial induration of the lungs.
Gerhard on Pneumonia of Children. 329
It remains to inquire whether the disease termed pneumonia in chil-
dren, is identical with the same affection in adults, and what relation
anj modifications of it may bear to the different ages of childhood.
In short, the pathology of the disease must be studied as thoroughly
in the infant as it has been in the adult, and then the conclusions
must be compared with those furnished by the latter class of patients.
The following observations are designed to supply in a small degree
the lacuna^ they were collected during the years 18S2 and 1833 at
the Children's Hospital of Paris, and include a series of all the cases
of pneumonia admitted during more than a year into one of the two
divisions of the hospital destined to the treatment of acute affections.
The number of my own observations analyzed in the first se-
ries, is twenty-four. M. Rufz has allowed me to examine, under
some points of view, sixteen cases which he had collected. Care was
taken to avoid all unnecessary causes of error, by bestowing much time
and attention on the examination of each case. The results obtained
from the examination of these series of observations ol children were
entirely unexpected to myself, and therefore free from the bias of
preconceived opinions.
Opinions not closely connected with facts, are least of all admissi-
ble in inquiries into the diseases of children, in which, although
there are not often many complicated lesions, the diagnosis is ex-
tremely obscure from the small number of points upon which it must
depend. Much more time must therefore be spent in ascertaining
with accuracy the existence of the few symptoms which can be sub-
jects of observation in children. Thus, in the class of diseases now
examined, we have rarely the sputa, or the exact seat of pain, and
are deprived of much of that collateral evidence which so much as-
sists the diagnosis of the diseases of the adult. I was long since con-
vinced of the necessity of fixing thoroughly the value of all the symp-
toms in diseases of children, however unimportant some of them seem
when applied to the affections of adults where the great pathognomonic
characters are easily recognised, hence an apparently undue weight
was attached to noting the precise appearance of the countenance,
of the external characters of the respiration, and other minor symptoms.
No one symptom maybe of itself pathognomonic, but the union of seve-
ral fixes the identity of the affection, and if the disease be not suffi-
ciently characterized, it is utterly impossible to reach any certain re-
sults as to its probable termination or curability.
I have divided all the cases which I could regard as observations
of the pneumonia of children into two distinct classes. The first in-
cludes those cases of pneumonia which offered several of the charac-
28*
330 Gerhard on Pneumonia of Children,
teristic symptoms of the same affection in adults, such as pain, cre-
pitous rhonchus, bronchial respiration, bronchophony, sometimes vis-
cid sputaj — all this first series terminated in recovery with a single
exception, and all were limited in their duration. The age of the
subjects varied from six years up to puberty, none of the younger
children presented a corresponding series of symptoms.*
The second series includes all the children who could be regarded
as affected with pneumonia other than those above-mentioned 5 these
were all young, not exceeding the age of six years, and presented a
succession of symptoms very different from those observed in the
pneumonia of adults. The induration of the lung was scarcely ever
confined to a single one of these organs 5 it began by a number of de-
tached nuclei, instead of commencing in a limited point of the pul-
monary tissue; the duration of the disease was not limited, and in a
large proportion of cases it terminated in death.
I have stated a few of the obvious points of difference between the
two classes of observations, so that the general reasons for the clas-
sification might be seen. Upon entering into a more minute history
of the two varieties, the distinction will become more obvious.
The number of cases of the first series was forty, and of these a
single case terminated fatally; therefore the identity of the anatomical
lesions with those of the pneumonia as observed in more advanced life,
can only be shown in this single example. The very small mortality
proves that this form of pneumonia which affects children after the
second dentition, is not a very fatal disease; an inference which we
may very safely draw even from a number of cases which are not suf-
ficiently numerous to furnish an exact general ratio of the mortality.
We know from correct observations on the pneumonia of adults, that
it is rarely fatal until after the age of forty -five or fifty, and in the
later stages of life its mortality is immensely increased. We may
therefore state it as a law in pathology, that pneumonia, between the
ages of six and fifty, is rarely fatal. These cyphers are based on the
results of the Parisian hospitals.
* of course the term pneumonia is here confined to those cases in which the
affection of the lungs was the primary disease, and occurred in children who
were in perfect health or at least free from any disease which could g-ive rise to
inflammation of the lungs as a mere secondary lesion. In other words the term
pneumonia is given to those cases only in which the first appreciable local affec-
tion was the pulmonary inflammation. When pneumonia is a mere accidental
or secondary lesion occurring during the course of a disease, such as small-pox
or phthisis, the symptoms, termination and treatment are widely different from
those of the primary affection.
Gerhard on Pneumonia of Children, 331
Case. — Charles Roger, set. 9i, admitted March 20th, 1833. On the
morning of the 18th he was taken with fever, cough and pain in the
side, the fever augmenting in the evening. Cephalalgia, but neither
vomiting nor diarrhoea. Well-nourished, eats at the table of his
mastery does some light work in a paper manufactory. Health per-
fectly good before the 18th.
Present condition, March QOth, 6 P. M. — Hair dark -brown, eyes
dark, skin brown, moderate embonpoint. Countenance anxious^
strong dilatation and movement of the nostrils^ lips swollen, dark-
red; large circumscribed purple spots on each cheek; eyes brilliant,
slightly injected; decubitus dorsal, inclined to the left; intelligence
dull; stupor constant; frontal cephalalgia; no delirium; senses seem
perfect; subsultus frequent in the tendons of both forearms; tongue
yellow, thickly coated; no pain in the throat; appetite for apples and
bread; thirst; abdomen hard, distended, and throughout tender on
pressure; no typhoid spots; no nausea; one dejection; respiration high,
irregular, forty-seven in the minute, heard at a distance; pulse 132,
quick, irregular, not very strong; cough rare; pain in abdomen and
lower part of right side of the chest increased by the cough; skin hot
and dry.
9,1st, morning. Pulse 132, irregular; respiration 40; same counte-
nance; left cheek less coloured than the right; stupor; respiration in the
base ofthe right side, scarcely vesicular, without expiration, but obscure
and not expansive, although not bronchial; no rhonchus; on left side
respiration pure and expansive; percussion slightly obscure through-
out the left side; eight leeches to right side of chest, followed by a
cataplasm; gum linctus; mucilaginous enema; diet; pain diminished
a little after the application of the leeches, v»^ithout amelioration of
the pulse or other symptoms; in the evening same symptoms.
On the 22d, Flatness on percussion in the whole posterior part of
the right side of the thorax, and evident obscurity of sound in the
anterior part; respiration scarcely heard on the right side, but not
bronchial and pure; no change occurred in the physical signs until
the 26th, when the respiration was blowing, (soufflante,) or imper-
fectly bronchial in the superior third of the posterior part of the right
lung; bronchial with strongly marked expiration in the middle third,
and abundant crepitant rhonchus at the base. On the 27th, fine
crepitus in the whole posterior part of the right, except the subsca-
pular fossa; the crepitus extends iiito the axilla, where it ceases ab-
ruptly; respiration pure in the left lung, except posteriorly a little
below the middle, where a mixture of mucous sibilant and subcrepi-
tant rhonchi are heard; mucous and sibilant rhonchi in whole anterior
332 Gerhard on Pneumonia of Children.
part of right lung; slight obscurity on percussion, but no resonance of
the voice throughout the right side of the chest.
27th. Crepitus larger, approaching mucous rhonchus on the right
side; crepitus distinct in lower part of left side; no change in the
physical signs occurred on the 28th.
oOth. Abundant liquid mucous rhonchus in the whole extent of the
right side; same rhonchus, but less abundant and less liquid in left
side. Percussion not changed from last date. Decubitus variable,
generally dorsal, apparently equally possible on either side. Cough
frequent and loose during the whole disease. Sputa observed from
the fourth to the eleventh day of the disease; viscid; in part rust-co-
loured, and afterwards of a dirty yellow colour, with streaks of pure
blood. Pain in the side not complained of after the eighth day.
Respiration always high and irregular, from 40 to 50 in the mi-
nute, excepting on the seventh, eighth, and ninth days, when it
varied between 24 and 36. Pulse 132, not varying a single pulsa-
tion either on the morning or evening visit, until the seventh day,
when it fell to 108, afterwards gradually rising to 120 on the eve of
his death. On the last day too frequent and feeble to count. Heat
constantly elevated and dry. Feebleness extreme through the whole
duration. The stupor noted at first continued increasing until death.
Cephalalgia not felt upon the increase of the stupor, (after 27th.)
The sight was not evidently impaired, but eyes habitually closed,
and painful if exposed to light. Hearing preserved. Intelligence
obtuse; great irritability if disturbed, but answers correct until the
day before his death. Slight delirium at times, not constant. No
subsultus after the day of entrance. Sleep bad the last three or four
nights only. Tongue whitish, afterwards yellowish, except at edges,
which were dark red until the tenth day; afterwards dry, dark yellow
at centre, and red at the edges and swollen. Teeth fuliginous after
the tenth day, and gums where attached to the incisors of both jaws
softened, and of brownish, gangrenous appearance the two last days.
Breath fetid on the ninth day, becoming of a gangrenous odour to-
wards the close. No vomiting until the fifth day, when he began
taking a potion containing tartarized antimony. The some potion
was continued until the eleventh day, without exciting either nausea
or vomiting; on the last day frequent vomiting of a dark, slightly
flocculent liquid. Stools rare until the first dose of tartar emetic,
when there were two or three liquid dejections; afterwards the con-
stipation returned. Abdomen not tender, rather developed until the
two last days, when it seemed painful on pressure, and tense. The
countenance retained the expression of heaviness, becoming haggard as
Gerhard on Pneumonia of Children. 333
soon as the breath was fetid. Red, irregular, but circumscribed patches
on each cheek throughout the disease. Lips thick, livid, red, dry.
Death took place at the end of the thirteenth day.
The treatment consisted in two applications of leeches to the chest,
(eight and six,) on the fourth and fifth day. On the sixth day, a
potion was given, containing six grains of tartarized antimony, which
was continued with little variation until the eleventh day. The
child tolerated the antimony extremely well| almost no nausea during
the whole period^ on the eleventh day the vomiting of dark liquid
caused the suspension of the medicine. On the tenth day the quan-
tity of tartar emetic had been increased to eight grains in the twenty-
four hours, and two cups were applied to the right side of the chest.
The other applications consisted of hot applications to the extremi-
ties, injections, and the pectoral linctus. It is needless to mention,
that this depletory and contra-stimulant practice was without bene-
ficial result; the tartar emetic was perfectly supported until the su-
pervention of the dark-coloured vomiting.
Autopsy the 2d of Spril^ S^ d. M, thirty -one hours after death. — ■
Exterior. Moderate embonpoint. Greenish colour of abdominal pa-
rietes. Livid spots on the posterior parts of the body.
Thorax. Right lung adhering in its inferior half by reddish, soft
cellular adhesions, (recent.) Upper and middle lobes of a delicate,
rosy-fawn colour externally; tissue rosy, soft, containing air, with-
out trace of tubercles or emphysema. Inferior lobe on its anterior
half of the same aspect as the upper lobes. Posterior half of this
lobe in a breadth of one and a half to two inches at the middle; yel-
lowish-red, spotted with black patches, one to four lines in diameter,
apparently owing to effusion of blood into the pulmonary tissue; cut
surface finely granulated, the granulations yellowish, easily crushed,
not tuberculous, the largest of the size of a pin's head. Purulent
liquid issues abundantly from orifices which are easily traced to the
cut bronchial tubes, and the whole tissue is friable, and breaks into
reddish-yellow, puriform pulp. Bronchia rosy, and not thickened
in the upper lobe; reddish, thickened, and filled with puriform liquid
in the lower. Left lung not adherent; upper lobe fawn colour, not
tuberculous, rosy internally and permeable; lower lobe rosy and per-
meable to the air, except in its posterior and inferior fourth, where
its cut surface, density and friability, are precisely similar to those
of the indurated portion of the right lung. Bronchia rosy and trans-
parent, except in the affected part, whdre their contents and aspect
are analogous to those of the lower lobe of the right lung. Bronchial
334 Gerhard on Pneumonia of Children,
glands grayish, firm, size of large peas, not tuberculous. Pericar-
dium containing one ounce of limpid serositj. Heart one-half larger
than the fist of the child. Total height two and a half inches. From
interior of apex to free edge of aortic valves, three inches seven lines.
Development of left ventricle at its middle, three inches nine lines;
thickness of its wall at same place, without columnse carnese, six
lines, with them nearly ten lines. Development of aorta at valves,
twenty and a half lines. Thickness of right ventricle less than two
lines, height two inches eight lines; pulmonary artery twenty-two
lines. Tissue of heart deep red, firm; aortic valves contracted, rigid,
their usual cartilaginous concretions of the size of a millet-seed.
Slight cartilaginous induration of left auriculo-ventricular valves.
Eustachian valve closed. Aorta of yellowish, onion-peel colour in its
internal membrane only. Heart distended with dark blood, more
abundant in the left cavities.
Stomach contracted, contains a thick, blackish matter, similar to
that vomited the eve of his death. General hue of the mucous mem-
brane rosy onion-peel colour, a little opaque, without any injections.
Surface very irregular from a multitude of litttle depressions of same
colour as the rest, rounded, the largest a line in diameter, edges not
perpendicular; mucous membrane at bottom so thin as to render these
spots translucent, but not entirely destroyed. Membrane adherent
at these spots, with slight injection of the cellular coat in a few.
General thickness of the mucous tunic augmented; strips brittle, but
of the usual length, four or five lines in great cul-de-sac, six or eight
in great curvature, and twelve to fifteen in the small. Much mam-
millation near the pylorus, and a little at the central parts. Duode-
num grayish; follicles with central point numerous; contents yellow-
ish. Small intestine contains a blackish matter nearly similar to that
in the stomach. Mucous membrane throughout pale, a little opaque,
but consistence nearly natural; strips six to seven lines in the jeju-
num and ileum, except in the last five or six feet, where they are
only from three to five lines. Glands of Peyer white, less reticulated
than usual. Isolated follicles visible in last three feet, less than
millet-seeds; some with central point. Mesenteric glands small,
grayish, firm, not tuberculous. Large intestine containing through-
out the same blackish matter as the small intestine. Mucous mem-
brane throughout pale, a little milky; isolated follicles just visible,
in general with central point. Strips eight to twelve lines, firm.
Liver flaccid, dull-gray colour; the two substances little distinct,
greasing the scalpel a little. Bile green, rather abundant. Spleen
Gerhard on Pneumonia of Children. 335
four inches long, reddish-brown, firm. Kidneys dark-coloured in
the tubular portion, cortical substance violet-gray. Bladder a little
injected at the fundus, firm, containing a little troubled urine.
Head. Pia mater a little injected; about half an ounce of serosity
beneath the arachnoid, and a drachm in each lateral ventricle. Sub-
stance of brain firm, not injected. Spinal marrow firm and pale.
Mouth. Gums softened in whole extent corresponding to the incisor
teeth, of a dirty -gray colour and gangrenous odour.
I have given the details of the only mortal case amongst the sub-
jects of the first series, to show the perfect identity both of symp-
toms and lesions, with those presented by fatal cases of the pneu-
monia of adults. The right lung, which was primitively affected,
presented the granulated, indurated, but friable structure of an in-
flamed lung, between the second and third stages, that is, the degree
intermediate between the red and gray hepatization. The pleura
was inflamed on the side most affected. The extent of the lesion
was not so great as in many cases which terminated happily, and
perhaps this observation would not have had a fatal issue, were it not
for the lesions of other organs. The stomach was evidently much
altered. Had the tartar emetic any agency in the production of this
lesion? at least the increased dose coincided with the exacerbation of
the symptoms. The gangrene of the mouth was a very unfavourable
symptom; this affection supervenes in a large number of children la-
bouring under various diseases, and usually it has a mortal termina-
tion. The child's health previously to the commencement of the
pneumonia was good, excepting an affection of the heart, which was
shown only on dissection.
I have arranged the cases whose issue was fortunate in a tabular
form, which will include some of the leading symptoms in each case,
especially such as were necessary? to characterize the disease so
clearly as to render the diagnosis perfectly free from doubt. Some
such arrangement is adviseable to remove all suspicion of involuntary
errors to which an author might be exposed, and these details render
all wilful deception morally impossible, from the much greater skill
*' and labour necessary to invent and adapt together so great a number
of imaginary details, than would have been requisite to examine and
record facts. The table might have included all the data sought for,
were it not for the obvious typographical inconveniences, which oblige
me to give the simple analysis of many symptoms.
336
Gerhard on Pneumonia §f Children,
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29
338
Gerhard on Pneumonia of Children,
To this table are to be added three other observations which I col-
lected at the Children's Hospital: from accidental causes, parts of
these observations vt^ere mislaid 5 the portions which remain are sufl&-
cient to characterize the disease, which was cured in both the re-
maining cases.
NAME.
MONTH.
PHYSICAL SIGNS.
No. 22.
Boy, set. 8.
March.
Flat sound, bronchial respiration and crepi-
tus in the left side inferiorly.
No. 23.
Boy, set. 15.
November.
Bronchial respiration, bronchophony and
crepitus, with flat sound in lower two-thu-ds
of the right side.
The preceding cases are all those of which I have myself preserved
notes, but one of the whole number, (twenty -four,) was fatal. A few
others, the notes of which were either not collected or lost, would
have a little increased the number of observations of cure.
The following table is drawn up from the cases collected by my
friend M. Rufz during the same time that I was myself engaged in
observing the patients at the Children's Hospital; M. Rufz was occupied
in another ward of the same institution. The test of pneumonia in
all these cases was the existence of bronchial respiration, crepitus,
bronchophony, and a fiat sound on percussion occurring in subjects
healthy or nearly so; the symptoms in all came on suddenly, and
could not therefore be confounded with a tuberculous affection of the
lungs, and much less with pleuritic effusions.
Sex and Age.
Duration.
Month.
Side Affected.
Treatment.
No. 1.
Girl, aet. 6.
October.
Right.
White oxide of an-
timony.
No. 2.
Girl, xt. 12.
45 days.
March.
Right.
White oxide of an-
timony.
No. 3.
Girl, set. 8.
13 days.
September.
Right.
Venesection; re-
peated. Leeches.
No. 4.
Girl, set. 9.
14 days.
June.
Right.
Venesection. De-
mulcents.
No. 5.
Boy, set. 10.
May.
Right; up-
per lobe.
White oxide of an-
timony.
No. 6.
Boy, set. 14.
12 days.
April.
Right.
Venesection twice.
No. 7.
Boy, set. 6.
12 days.
April.
Left.
Venesection twice.
Gerhard on Pneumonia of Children.
f Table continued. J
339
Sex and Age.
Duration.
Month.
Side Affected
Treatment.
No. 8.
Boy, set. 14.
11 days.
April.
Right.
Venesection.
No. 9.
Boy, xt. 12.
12 days.
April.
Right.
Venesection twice.
No. 10.
Boy, set. 7.
April.
Right.
No. 11.
Boy, set. 12.
9 days.
October.
Left.
No venesection nor
antimony.
No. 12.
Boy, set. 14.
12 days.
August.
Left.
Venesection.
No. 13.
Boy, set. 13.
11 days.
May.
Right.
Venesection repeat-
ed several times.
No. 14.
Boy, set. 15.
23 days.
May.
Left.
Venesection; re-
peated.
No. 15.
Boy, set. 11.
13 days.
May.
Right.
Venesection.
No. 16.
Boy, set. 12.
14 days.
April.
Right.
The treatment is not given in detail, it was our intention at the
time the table was made out, merely to examine the duration of the
disease as treated with or without bleeding and the antimonials. The
list includes all the cases obserjed by M. Rufz, who did not witness
a single fatal case. The patients enumerated in the table made out
from M. Rufz's observations, were treated by MM. Guersent and
BAUDELocquE, the cases collected bj myself were from the wards of
MM. Jadelot and Bonneau. The whole number amounts to thirty-
nine successful, and one fatal case. In other words, in the whole
Children's Hospital during the year 1833, and a part of 1832, forty
cases of pneumonia occurring in children from the age of six upwards
were observed, and of this number but one was mortal. The patients
were not selected, but were treated by all the different physicians of
the hospital, and were observed at all seasons of the year, so that the
ratio of one mortal case in forty is based upon the greatest possible
variety of patients, seasons and methods of treatment^ and the pro-
portion must represent the general law as exactly as it can be deduced
from a moderate number of cases. In private practice the mortality
should be even less considerable, because the patients sent to an hos-
340 Gerhard on Pneumonia of Children.
pital, and especially to the children's, were such as presented disease
of a severe form, that is, they were generally selected from, amongst
the whole mass of the poorer children affected with any one disease.
It must also be recollected that neither simple bronchitis nor pleurisy
are included in the tables which are confined to the cases presenting
undoubted evidence of the existence of inflammation of the pulmonary
parenchyma; that is of a more severe disease than some of the affec-
tions which are occasionally confounded with pneumonia. The ne-
cessary conclusion from these facts is, that pneumonia in children
above the age of six years, either healthy or but little diseased, is
rarely fatal. Of course this proposition is based upon the cases treat-
ed at the Children's Hospital, it remains for us to examine the appa-
rent modifications produced by the different therapeutic means that
were employed.
The sex of the children was noted in each case, but it was only
during the last nine months of 1833, that the cases were collected si-
multaneously in the two divisions of the hospital; the relative num-
bers for this time are twelve boys and four girls, or three to one. In
adults the number of men affected with pneumonia is greater than that
of women, but the difference is less considerable than in children.
The seasons of the year are noted in the tables. The forty cases
occurred in the following months. January, five; February, two;
March, seven, including the fatal case; April, eight; May, four; June,
one; August, one; September, four; October, three; November, one;
December, four. In the three spring months nineteen cases were
collected; in the winter months eleven; in autumn eight; and in the
summer but two. The particular months most favourable to the pro-
duction of pneumonia were April a'^d May; those least favourable
were July, in which no case occurred, June and August, in each of
which there was but one example. This result is similar to that ob-
tained amongst adults,
S^e, — The youngest in the tables were six years of age; a single
patient had reached the age of sixteen. The mean age for the
twenty-four cases which I collected was a fraction less than ten
years, the average of the sixteen cases of M. Rufz a fraction less
than eleven. The whole number gave an average of ten years and
a third; had the fractions of years been estimated in the calcula-
tions of the ages, the mean number would have been about eleven; a
result showing that pneumonia becomes more frequent as we approach
the age of puberty.
Duration^ — I had sufficient data to establish the beginning and
the termination of seventeen of the cases of recovery. The com-
Gerhard on Pneumonia of Children. 341
mencement of the disease was not dated from the first precursory
symptoms, such as restlessness, cephalalgia, or other uneasy sensa-
tions, but from the pain in the side, chill, or severe cough, which in
every case came on suddenly, so as to render the proper commence-
ment of the affection very distinct from the prodromes. The termi-
nation was fixed at the complete disappearance of the physical signs,
that is, after the cessation of the secondary crepitant rhonchus,
which succeeded to the bronchial respiration and bronchophony.
The cessation of physical signs of the disease affords the most simple
and easy means of marking out a limit for the disease^ the general
symptoms did usually not continue as long as the physical signs.
The mean duration of the seventeen cases collected by myself, in
which the commencement and termination of the symptoms were as-
certained, was nearly fourteen days and a third. Of thirteen cases
from the series of M. Rufz, the mean duration was a little more than
twelve days and a sixth. This difference did not depend on the
greater age of most of the patients observed by M. Rufz, for the du-
ration of the pneumonia in the eight children below the age of ten
years, whose cases are included in the seventeen observations of the
first table, was fourteen days and three-eighths, or but a little longer
than the mean duration of the whole seventeen cases. It is then ob-
vious, that a cause of the difference must exist, other than the mere
inequality of the ages. This cause can scarcely be found in the sea-
sons of the year, for the cases collected in both tables were not con-
fined to any particular season. There remain but two ways of ac-
counting for the difference in the results, the one is by supposing
that the convalescence in the two series was not dated at the same
period of the affection; the other is by referring the inequality of time
to some difference in the treatment. In my own observations the
date of convalescence is fixed at the disappearance of the sub-crepi-
tant rhonchus, which usually succeeds the bronchial respiration of
pneumonia; in those of M. Rufz the tables were drawn up by us at
Paris, and the same cessation of the sub-crepitus was regarded as the
conclusion of the disease; still from a less rigorous exclusion of the
doubtful signs of disease, the termination was probably placed a little
earlier than in the cases which I had collected myself, and which I
examined more at leisure. The difference from this cause is, how-
ever, extremely small, not exceeding a day at most, and probably
the average would be only a fraction of a day. The remaining cause
of the difference in duration must be sought for in the various treat-
ment pursued; the influence of the therapeutic agents will be examined
in one of the following pages.
29*
342 Gerhard on Pneumonia of Children.
The lung primarilj or exclusively aifected with the inflammation,
was the right in twenty-six cases, and the left in twelve. In two
subjects, both lungs were nearly equally affected. The greater fre-
quency of inflammation of the right than of the left lung seems, there-
fore, still more considerable in children than adults.
The sputa of children are so rare, that this sign is of little or no
value in the exploration of their diseases; the few cases in which ex-
pectoration occurred are noted in the table.
The physical signs of course existed in every case of pneumonia
which I have analysed, or rather I regarded no subjects as certainly
affected with pulmonary inflammation, unless they presented the phy-
sical signs — crepitus, bronchophony, bronchial respiration, and flat
sound on percussion. Fine crepitant rhonchus existed in no case
without the bronchial respiration, and I met with no other case at the
Children's Hospital, amongst the older children, in which the general
symptoms of pneumonia and the crepitant rhonchus existed together,
without bronchial respiration. This coincides with what is observed
in adults; M. Louis stated to me, that he had not, upon examining
the observations collected by him during his clinical courses at La
Pitie, found any case of pneumonia without bronchial respiration.
It would appear, therefore, that the bronchial respiration in pneumo-
nia is at least as constant as the crepitant rhonchus. It is scarcely
necessary to mention, that bronchial respiration, bronchophony, and
diminished sonorousness of the chest must always coexist; in the cases
in which each of these signs is not enumerated, some accident had
caused the omission. The identity between the physical signs of
pneumonia is perfect, except that the crepitus is generally larger in
children, and if for a short time not heard, it may be generally re-
produced by making the child cough, when the crepitus is again
heard in the strong inspiration that succeeds the cough, giving rise
to a sound like the crackling of a quick-match.
The pulse was always frequent during the early periods of the dis-
ease, and became slower as convalescence approached. The relative
frequency of the pulsations is indicated in the table.
The respiration affords a better test of the degree of the pulmonary
affection, than the pulse. It is besides much more easy to count the
number of inspirations and examine the movements of the respiratory
muscles, than it is to ascertain the frequency of the arterial pulsa-
tions, especially if the child be at all restless and irritable. The
table will show, that the number of inspirations in the minute was
in one case 73, in others it varied from 30 to 50, but always de-
creasing during convalescence to the normal standard, which in chil-
Gerhard on Pneumonia of Children. 343
dren of this age during convalescence, or in health, is from 20 to
24. Besides the increased number of inspirations, the respiration
presents other alterations in pneumonia, it is high and abrupt; this
abruptness is particularly shown during the inspiration which comes
on suddenly, before the expiration is as prolonged as it is in health.
The last column in the tables contains a summary of the treat-
ment. The particular remedies are not mentioned, but each vene-
section or application, either of leeches or cups is noticed; the other
remedies of apparent activity are also noticed. I shall attempt the
analysis of the cases, vi^ith reference to the mode of treatment pur-
sued in each, compared with the duration of the disease. Sixteen
cases in the first table include a note of the treatment, and a state-
ment of the duration of the disease. In one-half of this number of
patients blood was taken from the arm; the other eight, with three
exceptions, were cupped or leeched upon the side affected. The
duration of pneumonia in the eight patients who were bled from the
arm, was fifteen days and a half, that in the other eight, was thirteen
days and one-eighth; the latter number approaches the cypher of du-
ration deduced from the second table. But nearly all the patients
whose cases were collected by M. Rufz were bled, and generally
much more copiously than the patients whom I had myself observed;
and the shorter duration of the disease in a part of the cases of the
first table could not have been owing to the omission of venesection*
The mode in which venesection was practised, was not however the
same in both cases. M. Guersent, in whose wards most of M. Rufz's
cases were collected, is in the habit of ordering more copious and
more frequently repeated bleedings than either M. Jadelot or M.
Bouneau, whose patients I had observed; however questionable the
propriety of free blood-letting may be in most of the diseases of chil-
dren, in the form of pneumonia which I am at present examining, the
larger abstractions of blood seem to have had a happy influence. In
the cases of the first table the bleeding was confined to the more se-
vere forms, and was not frequently repeated; but in the second series
of cases, venesection was resorted to in most instances, whether the
disease was severe or mild, and when requisite the bleeding was re-
peated more than once. The immediate effects of the venesection
in each case were to relieve to a certain extent the more troublesome
symptoms, such as the cephalalgia, restlessness, and dyspnoea; in no
case did it seem to produce an immediately injurious effect. The
conclusion would then be, that although pneumonia, whether treated
actively, or merely by topical blood-letting and demulcents, is rarely
fatal in children above the age of six years; stillj more copious vene-
344 Gerhard on Pneumonia of Children*
section shortens, to a certain extent, the duration of the disease, and
relieves the most harassing symptoms. This conclusion is nearly
analogous to that which M. Louis has deduced from the analysis of
his cases of pneumonia in adults. No exact tables have yet been
given of the comparative mortality of pneumonia treated with or
without bleeding. It is true, a physician, in cases of severity is not
justified in omitting venesection; but cases occur not unfrequently in
which patients have either not been seen by a physician, except to-
wards the termination of the disease, or in which some peculiar cir-
cumstances have prevented their medical attendant from resorting to
the use of the lancet. Whether the mortality be much diminished
or not by blood-letting in pneumonia, it is not the less important to
resort to it as a means of shortening the affection, and of diminishing
the severity of the most painful symptoms.
In several cases the preparations of antimony, given according to
the Italian method in large doses, were tried. The disease was not
obviously shortened, and the only case which terminated fatally was
treated by this method. I am very far from asserting that the tartar
emetic, or the white oxide of antimony, may not be useful in chil-
dren above the age of six years, who may be affected with pneumonia;
but the advantage that may result from this treatment was not evi-
dent in the small number of cases in which I saw it tried. The phy-
sician who had prescribed the antimony in several cases, among
which was the only fatal one, thought that the value of the remedy
was shown by the successful results. This incident affords us another
proof of the extreme difl&culty of ascertaining the exact value of thera-
peutics, however clear this part of medical science may seem to many
physicians.
The other remedies employed at the Children's Hospital in the
treatment of this form of pneumonia, were blisters, sinapisms, with
the internal administration of potions made of gum Arabic sweetened,
and sometimes rendered tranquillizing by the addition of small doses
of opiates. These remedies are, of course, merely designed as pal-
liatives, and their utility is shown by the immediate relief of some of
the harassing symptoms.
The preceding analysis of the cases of pneumonia occurring in
children after the second dentition, includes all the details which
were enumerated in the tables; these details embrace the more im-
portant points. Other symptoms are less easily analyzed, from the
difficulty of eliciting the same minute details from children that are
easily to be obtained from adults. The frequency of a chill at the
beginning of the disease could not be ascertained, although the chil-
Gerhard on Pneumonia of Children. 345
dren who recollected the existence of the chill could give as accurate
details of its phenomena, such as shivering, and a desire to approach
the tire; the absence of this symptom could not be satisfactorily es-
tablished by the want of recollection, or the inattention of other pa-
tients. A chill certainly took place in the greater part of the patients,
and probably in all. Pain in the side affected, occurred in every
case; this pain was acute, augmented by the cough, and was gene-
rally felt at the lower part of the axilla, most frequently at the ante-
rior than posterior margin.
The temperature of the surface was elevated in every case; in the
severe examples the skin was dry and rugous, and in one case com-
plicated with diarrhoea, the skin remained harsh and dry for some
■weeks after the cessation of the symptoms of pneumonia. Anorexia
was constant during the early periods of the disease; the appetite was
destroyed much more completely than in most other diseases of chil-
dren; the dyspnoea and great anxiety destroying completely all de-
sire of food. Constipation to a greater or less degree existed in about
three-fourths of the cases; in one there was diarrhoea of some in-
tensity.
Vomiting occurred in seven of the twelve cases in which the pre-
sence or absence of this symptom was ascertained; as in other dis-
eases, children attacked with pneumonia are, in the majority of casesj
taken with vomiting as one of the first symptoms.
The cerebral functions were altered to a certain extent in all the
more severe cases; the intelligence was dull, the patient lying in a
state of stupor, which nearly approached coma, even in one or two
of the cases which terminated happily. It was nearly impossible to
determine precisely when delirium occurred, on account of the ab-
sence of that minute observation, which is necessary to discover the
aberrations of the intelligence in children. Delirium was evidently
present in several cases; in others it was doubtful whether it existed.
To conclude this account of pneumonia in the older children, I
shall give one of the observations analysed in the table. The obser-
vation is selected on account of the short duration of the severe
symptoms.
Case. — Landry, (Angelique,) a girl, set. 10 years. Entered
September 5th, 1833. Taken ill on the 1st with head-ache and
fever, but neither chill nor epistaxis; anorexia; constipation; heat of
skin; cough two days after commencement, but without pain in the
side; thirst great.
Actual state, September 5th. —Moderate embonpoint; skin sallow;
decubitus dorsal, but possible on either side; cheeks red, in patches;
nostrils dilating at each inspiration; lips dark red, dry; intelligence
346 Gerhard on Pneumonia of Children,
Yery goodj no cephalalgia; senses perfect; sleep good; tongue thick,
moist, clean, rather dark red; thirst great; anorexia; no dejections;
abdomen not distended, not tender; urine not painful; cough mo-
derately painful, dry; sputa whitish, very rare; pulse quick, regular,
124; respiration high, 52 inspirations per minute. Thorax. Reson-
ance on percussion good in both sides of the chest anteriorly, rather
less on the right than the left side; respiration on the left side, ex-
pansive, pure and without expiration; on the right less expansive with
bronchial expiration at the lower part of the chest; posteriorly per-
cussion flat in the lower part of the right side only; respiration in the
left side, expansive and pure, without expiration in the right; blowing
or rude with marked expiration superiorly; in the lower part of the
lung respiration nearly bronchial; crepitus heard only after coughing
in the lower part of the lung; resonance of the voice distinct at the
lower part of the right lung; twenty leeches, one-half to the chest,
the other to the epigastrium; demulcent drinks and diet.
On the 6th abdominal symptoms unchanged; sleep bad, but intel-
ligence good; pulse 108, regular, feeble; respiration 35, less elevated;
bronchial respiration in whole right side posteriorly, especially in the
upper half; vibrating bronchophony at the middle third of the right
lung, nearly similar to egophony. Gum linctus; gum water; cata-
plasms to chest; milk.
7th. Pulse 84, natural, but rather feeble; respiration 28, not ele-
vated; appetite; no thirst; heat of skin scarcely more than natural.
Crepitant rhonchus more abundant after coughing in the whole pos-
terior part of the right side; rude respiration still distinct in the up-
per half.
On the 8th respiration 20; pulse 76, of natural volume. Respi-
ration in the upper part of the right side less bronchial; crepitus still
continues. Gum water; broth.
On the 12th a little crepitus was still heard about the middle of
the right lung, after coughing. After the 12th respiration natural,
except slight feebleness on the right side. Pulse increased in fre-
quency to 108 on the 11th, afterwards falling during convalescence,
which was protracted until the 18th, when the girl was discharged well.
This observation is the least severe example of this variety of
pneumonia that I have witnessed. The effects of the application of
the twenty leeches, (equal to about fifty American,) were almost im-
mediate; the frequency of both pulse and respiration decreasing, but
the local symptoms did not abate until two days later.
In the next number of this Journal I shall examine the pneumonia
of children below the age of six years; this second variety differs in
many respects from the affection which has just been described.
Pennock on Elephantiasis, 347
Art. IV. Observations on Elephantiasis, By C, W. Pennock, M. D.
of Philadelphia.
Among the numerous institutions of Paris which are devoted to
medicine, no one surpasses in importance and interest the Hdpital
St. Louis. This noble establishment is situated on a high eminence
near the north-eastern part of the city, and was originally founded by
Henry the Fourth in the year 1607 as a receptacle for the leprous.
For a long period this antique structure received scarcely any atten-
tion from the foreign medical visitor. Situated far from the centre
of the city, not attached to the medical school, and not presenting
men of genius or industry among its clinical professors, it was consi-
dered merely as a receptacle for incurable diseases, and the student
found nothing to repay him for his visit to a scene of misery and dis-
tress. It was reserved for Professor Alibert to change this feeling,
and to place the Hopital St. Louis among the most celebrated of Eu-
rope. This eminent professor first directed the attention of patholo-
gists to this institution by his work on the diseases of the skin.
Since that time its importance has been properly appreciated.
The eminent names of Biett, Alibert, Lugol and Richerand
occur, in the list of its clinical professors, and crowds of students
from the different quarters of the globe avail themselves of its medical
advantages. The hospital contains upwards of a thousand beds, and
though from its original destination it receives many chronic cases,
yet from its locality, its doors are necessarily open to different acute
and surgical diseases.
The division under the charge of MM. Biett and Alibert com-
prises two hundred and twenty beds. During a visit to Paris in
1832-3, through the kindness of these gentlemen I obtained free
access to their wards. It was however principally in the service of
M. Biett, who had under his direction one hundred and sixty pa-
tients distributed in four wards, remarkable for their beauty and
convenience, that I made most of my observations on cutaneous
diseases. M. Biett facilitated any inquiries by every means iu
his power, and it is to him and to M. Martins, the aide naturaliste
of the school of medicine and the interne at St. Louis, that I owe
the greater part of the notes I have made. The observations are
about a hundred in number, and I propose selecting from them such
as may exemplify the practice of that eminent pathologist. Before
presenting any of these cases, I would observe, that I have consider-
ed the classification of Bateman and Willan as adopted by M.
'348 Pen nock on Elephantiasis.
Biett, as preferable to that of M. Alibert. The first cases which are pre-
sented are those of elephantiasis which were in St. Louis in 1832. The
pathological history of this aftection is exceedingly imperfect; much is
yet to be desired, and the investigation of the disease offers a wide
field for observation. The object of the writer is to present the sub-
ject to those whose opportunities may be favourable to its eluci-
dation.
Elephantiasis of the Jlrabs complicated with frambcesia, — Barbier,
aged twenty, by profession a joiner, entered the Hopital St. Louis, ser-
vice of M. Biett in the autumn of 1833. In the month of December,
I collected the following facts respecting his case.
He was born in the Department of Haute-Saonej has never been
in tropical climates, but has always lived in France, and his parents
were free of all cutaneous disease. His nourishment has always been
good. During the first years of childhood until he was nine years
of age, he enjoyed good health; from that period until the age of
seventeen he was affected with a succession of abscesses in the groins,
on the neck, arms, and at the sternal extremity of the left clavicle.
From the appearances of the cicatrices, there is no doubt, but, that
these abscesses were scrofulous. They are of a brown colour, almost
livid, intermixed with white, of an irregular form, and an uneven
surface.
The present affection commenced two years ago, immediately above
the great toe of the right foot, by a slight elevation and discoloration
of the skin, attended with local pain and some fever; these symptoms
were followed by a small, soft, projecting tumour of a red colour
which bled upon the slightest touch.
Six months afterwards the patient contracted a Menorrhagia, which
ceased in a month under the treatment of injections of infusion of
marsh-mallow, drinking the decoction of sarsaparilla and the liquor
of Van Swieten. No secondary symptoms followed, but the cutaneous
affection was subsequently augmented; since that time he has not had
any venereal symptoms. The disease extended itself by the succes-
sive formation of the spongy tissue from the toes to the superior part
of the thigh. It presents, according to its degree, four principal
forms.
First. A small, indolent, subcutaneous tubercle of the size of a pea,
causing a slight elevation of the skin. This is the commencement.
Second. Convex elevations exactly circular rising from one to four
lines above the skin, surrounded by a brown circle varying in diameter
from a quarter of an inch to one and a half inches, of a red colour,
soft, spongy, analogous to the fungus of woun»ls, and bearing some
Pennock on Elephantiasis. 349
resemblance to raspberries lying side bj side, and exudino; a red
serositj.
Third. Masses formed by the union of the above, but of irregular
forms, of variable size, covering the leg and the inferior part of the
thigh. The greater part of these tubercles have the same appearance
as those which are isolated. Where the healing process has com-
menced the surface is drier, less elevated, and not so irregular. At
the superior and inferior part of the leg the vegetations have the
forms of small fleshy tongues, imbricated, resembling the crest of the
cock.
Fourth. Cicatrices, which are sometimes large, smooth, of a v/hite
colour, slightly elevated above the healthy skin; sometimes the fun-
gosities seem to have dried up without changing form, and have as-
sumed a brown, livid appearance.
The union of all these alterations have changed the form of the
limb, and gives it the appearance of the elephantiasis of the Arabs.
The circumference of the superior two-thirds of the diseased leg is one
inch more than that of the corresponding part of the other: the in-
ferior third is one inch and three-quarters more than the left. The
limb is the seat of excessive itching, and when cauterization is at-
tempted by the per-nitrate of mercury the patient suffers excruciating
pain. With the exception of the cutaneous affection his general
health appeared good during the winter of 1833-4. Treatment — Infu-
sion of hops for habitual drink, with 5ij- Sub-carb. soda, per Oj. ; al-
kaline baths daily, and cauterization with per-nitrate of mercury,
(nitrique acide de mercure.)
^pril and May. — After the first of April, excessive diarrhoea com-
menced, attended with extreme prostration of strength; the tongue was
red, dry; thirst extreme; abdomen slightly painful upon pressure;
the pulse frequent, (88,) and feeble; his usual cheerfulness forsook
him, his mind became depressed, and he complained bitterly of his
situation. The diarrhoea was arrested at intervals by regulating his
diet, and by opiates and astringents," but was renewed by the impru-
dent excess of the patient. During this time the vegetations, (fun-
gosities,) and the tissue of the cicatrices ulcerated, and the diseased,
limb was covered with extremely painful ulcers, very irregular in
their forms, their edges perpendicular, and internally of a grayish
colour. The slightest pressure upon them produced an exudation of
very foetid pus. With these symptoms the patient died on the second
of June.
Autopsy^ thirty hours after death. — The skin on every part of the
diseased limb was thickened, and with the cellular tissue beneath was
No. XXVIIL— August, 1834. 30
350 Pennock on Elephantiasis.
from one-fourth of an inch to an inch and a half thick. On the cica-
trized points the epidermis was smooth, and beneath this the entire
thickness of the cellular and adipose substance, with the exception of
a few isolated masses of adeps, was replaced bj a white, fibrous, apo-
neurotic tissue, which was firmly attached to and blended with the
dermis. In the points in which cicatrization had not commenced,
the epidermis appeared detached from the dermoid mucous tissue,
which was red, thickened, slightly uneven, (mamelonne,) bearing
some resemblance to the intestinal mucous membrane, and could be
raised without dissection from the subjacent adipose layer. In the
middle of the thigh between the sartorius and rectus femoris muscles,
was an abscess of the size of a goose-egg, containing a white, tenacious
pus; and on a level with the internal malleolus, all the cellular
tissue for the space of two inches was changed into a sanious mass of
a slate-gray colour, and of a foetid odour. At the external healthy
parts of the leg, the adipose substance was two lines in thickness,
soft, and of a clear light-yellow colour; in the diseased parts, on the
contrary, it was an inch thick, and separated into masses by a white
tissue. This tissue was firm, resistant, and was penetrated with dif-
ficulty by the scalpel; the cells formed by the interlacing of its fibres
contained beside the adeps, a great quantity of serous and gelatinous
fluid. In the parts which were highly diseased, the skin was entirely
destroyed, and the ulceration extended to the adipose layer; on the
internal and superior part of the leg and beneath the aponeurotic
fascia was an abscess of the size of a hen's egg, containing greenish
pus, and partly lined with a false membrane. The tunics of the in-
ternal saphena vein were thickened, and when cut across, the cut ex-
tremity remained open like an artery. The tendons, bones and pe-
riosteum were healthy.
Thorax. — A small group of tubercles were found at the summit of
the right lung. Near these was a cavity traversed by fibrous bands,
and was evidently a cicatrized tuberculous cavern. The rest of the
lungs crepitant, and floated when thrown on water.
Heart. — The heart was soft, and the parietes of the ventricles
thin.
Abdomen. — The liver was much enlarged, it not only occupied the
epigastric region, but extended into the left hypochondriac; the vo-
lume of the left lobe was almost equal to that of the right, its entire
weight eight pounds. Externally and internally it was yellower than
usual. The gall-bladder contained a greenish bile; its ducts were
unobstructed. The mucous membrane of the stomach, and the intes-
tines in their entire extent had its normal colour and consistence.
Pennock on Elephantiasis, 351
There was neither redness nor softening, nor induration of this
tissue.
Remarks. — The hypertrophy of the adipose substance, the hard-
ness of the cellular tissue, and the effusion of serosity and gelatinous
fluid, leave no doubt of this disease being an elephantiasis of the
Arabs. These characteristics, and more especially that of the pre-
sence of the serous secretions, has induced M. Bouillaud to consi-
der this disease as bearing a strong pathological resemblance to the
oedema of phlegmasia dolens of women. It is much to be regretted,
that the details of the case have not been collected with more preci-
sion 5 some interesting facts are however deducible from it. The
disease occurred in a tuberculous subject^ it supervened upon the
healing of scrofulous abscesses, and the appearance of framboesia oc-
curred before the patient had contracted any venereal disease. M.
Alard, to whom the medical profession is greatly indebted for the
lucid manner in which he has examined the history of this disease,
assigns as one of the causes of its production the suppression of some
habitual evacuation — in this case the coincidence of the suppression
and the appearance of the disease is presented. M. Alard has not,
however, been able to collect a sufficient mass of evidence to esta-
blish the fact; the present case is, therefore, oSered merely to excite
further observation. Although Alard mentions, on the authority of
Hendy, that framboesia complicates the disease, yet he has not given
any detailed case of its concurrence. Judging from the circumstance
of its being rarely mentioned by authors, it cannot occur frequently.
Framboesia has been placed by a distinguished writer among the sy-
philitic diseases. In this case it occurred in a person whose parents
had been free of any syphilitic taint, and previous to his exposure to
infection. Elephantiasis of the Arabs seems to have been first
described by Rhazes. The name has been the cause of much con-
fusion, and it was not until Hillary and H?:ndy of Barbadoes gave
their account of the glandular disease of that island, that the profes-
sion appear to have had any definite notions upon the subject. The
medical world is indebted to those authors for the suggestions of its
being a disease in which the glands and lymphatics are particularly
and principally affected. Alard, with great research and with inde-
fatigable industry, has investigated the subject very thoroughly, and
proves, from a comparison of the symptoms, that the glandular dis-
ease of Barbadoes of Hendy, the perical and andrum of Ceylon, the
colic of Japan, the elephantiasis of Rhazes, the fleshy hernia of
Prosper Alpinus, and the sarcocele of Egypt, are pathologically the
same disease. It is not the intention of the writer of this communi-
cation to enter into a detail of his reasoning, and he begs, therefore,
352 Pennock 07i Elephantiasis.
to refer to the author in question. Previous to leaving the subject,
he would wish to state, that Alard found this disease infinitely more
common in Europe than was supposed, and the truth of this observa-
tion has been confirmed by Alibert, Rayer, and Biett.
Respecting its pathology, the writers are not unanimous in their
opinions. Alard considers it as uniformly depending upon an in-
flammation of the lymphatics; Biett and Rayer acknowledge that this
is frequently the case, but that it is not necessarily the primitive af-
fection, and that it may occur as a secondary lesion after the en-
largement of the other tissues. M. Bouillaud* reports a case oc-
curring in a woman, in which the inferior extremities were enor-
mously distended and exceedingly hard, the disease resembling
exactly elephantiasis. Upon a post mortem examination, it was
found that the skin and subjacent cellular tissue were an inch
and a half thick, having the appearance of the skin of the hog;
that the lumbar portion of the vena cava, and all the veins of the in-
ferior extremities were obstructed by deposition of fibrinous matter.
The lymphatics were healthy. Hypertrophy in this case would seem
to be consecutive upon obliteration of the veins. In the present
state of the science, the question of the inflammation of the lympha-
tics is not determined, and is thus left as a problem to the pathologi-
cal observer.
The anatomical investigations respecting this disease seem to have
been limited principally to the local examinations of the affected
part. The pathological researches have not been extended to the
internal viscera, and hence the history of the disease in that respect
is exceedingly obscure.
Hendy has found the lymphatic ganglions hardened, or in suppu-
ration, and larger than natural; the absorbents were dilated, having
their parietes so enfeebled, that it was impossible to distend them by
an injection. The areolar structure of the cellular tissue is distended
by a thick, viscous, gelatinous fluid, mingled with a serous fluid. The
cellular tissue is found much developed and hardened. The
skin may preserve its natural colour and appearance, but it gene-
rally presents an alteration of structure; it is ordinarily much thick-
ened.
M. Andral reports a post mortem examination of a patient in
whom one of the legs was enormously distended by elephantiasis.
Upon dissection of this limb, the subcutaneous and inter-muscular
cellular tis&ue was found hard and much developed, resembling the
sub-mucous cellular tissue when in a scirrhous state, indurated and
* Archives Generales de Medecine. Tome Ire, p. 567.
Pennock on Elephantiasis, S5S
becoming more dense as it approached the cutis vera^ this was much
thickened, and frequently could not be separated from the sub-cellu-
lar tissuef it was not, however, either injected or modified in its co-
lour. Above this was found a tissue evidently distinct from the
dermis, and which appeared to be to this what the villi are to the in-
testinal mucous tissue. Between these papillae and the epidermis
were three distinct laminsej one, the most internal, extremely
delicate, and which filled up the inequalities of the subjacent
papillae, was formed of a cellulo-fibrous tissue, and received no
vessels, it corresponds with the " couche albide profonde" of
Gaultier, or the " couche epidermique" of Dutrochet. A second,
exterior to this, composed of daric-coloured, delicate filaments, inter-
laced in every direction, formed a net-work analogous to the coloured
lamina of the skin of negroes. Finally, a third directly beneath the
epidermis, which was variable in thickness, sometimes merely pre-
senting a white line similar to that mentioned as overlaying the pa-
pillary structure, at other times thicker, harder, like a series of small
superposed scales, corresponding with the " couche albide superfi-
cielle" of Gaultier, and the "• couche cornee of M. Dutrochet.
From these facts it follows, that the dermis or cutis vera is com-
posed of two parts, which ordinarily confounded, have, however, so
dependent a condition upon each other, that it is only in certain pa-
thological states that they can be isolated.*
Much of the uncertainty of this disease doubtless arises from the
fact of numerous diseases pathologically different, being called by the
name of elephantiasis of the Arabs. Thus, some authors designate
by this title every enlargement or swelling of the cellular tissue of the
limbs, of the scrotum, of the face, independently of those by oedema
or infiltration of blood.
M. Alard restricts the appellation to a particular affection of the
skin, and the subcutaneous tissue and lymphatic system, which is
announced at first by the formation of a hard cord, which is painful^
knotted, following the course of the lymphatics and glands, and cha-
racterized subsequently by a swelling and permanent induration and
augmentation of the skin and cellular tissue, with morbid increase of
adipose matter, accompanied by a serous and gelatinous effusion in
the diseased parts, the dimensions of which often become enormous.
Various causes are assigned for the production of this disease.
Thus, insufficient nourishment, or food of a bad quality; excessive
heat, with a moist atmosphere charged with the exhalations from a
* Andral, Anatomic Pathologlque, Tome Ire, p. 169 a 175.
30*
354 Pennock on Elephantiasis »
marshy soil 5 extreme neglect of cleanliness, &c. are all considered
as being important agents in its production.
Climate unquestionably has a direct influence upon its formation.
In the Island of Barbadoes this disease is endemic, and cases of it
are so numerous among the inhabitants, that the title of " Barbadoes
leg" is one of its most common appellations. Hendy considers that
the destruction of the forests, which formerly covered that island, is
the cause of its remarkable prevalence. The temperature, in conse-
quence of this disappearance of the woods, is remarkably hot and
arid, and he refers the proximate cause of the disease to these cha-
racteristics of the climate.
Alard, who examines in detail the question of the causes, arrives
at the conclusion, that the formation of the disease is not owing to
the quality of the water, the nourishment of the individual, the heat,
dryness, or humidity of the climate, but that it depends upon sudden
exposure, when heated, to currents of air.* He also proves satisfacto-
rily from many observations, that the disease is neither hereditary
nor contagious.
The symptoms of the disease as given by this writer, are the fol-
lowing:— The attack is sudden and unexpected. At first a pain is
experienced in a gland, or in the course of the principal trunks of the
lymphatics^ these vessels are almost always hard, knotted, and pre-
senting the appearance of small, tumefied glands, which are often-
times discoloured. Sometimes the course of this cord which follows
the pain is indicated by a red line, unaccompanied by elevations; this
is always the case when the attack has been slight. The diseased
part becomes red, swells, and presents an erysipelatous appear-
ance, and is often phlegmonous. The concomitant fever, if the at-
tack be severe, is preceded by a chill, and accompanied by intense
thirst, nausea and vomiting; if the chill be severe, the reaction is
correspondent. After a longer or shorter duration the fever disap-
pears, and the affected part becomes swollen, and continues inflamed
for several days. The inflammation ceases, but the swelling and en-
largement continue; it appears to be oedematous in the commence-
ment of the disease, but after a few attacks, the diseased part be-
comes very hard, and does not yield to the pressure of the finger.
Frequent erysipelatous attacks supervene, and the permanent en-
largement, which is the consequence, soon manifests the character of
the inflammation. The disease may attack any part of the body,
but it ordinarily commences upon the feet or malleolus, by the ap-
* Histoire de 1' Elephantiasis des Arabes, par Alard. From page 323 to 354.
Pennock 07i Elephantiasis. 355
pearance of small, red lines, which soon extend to the legs and
thighs.
GuiLLEMEAu, who studied the disease very attentively in the Isle
of France, remarks, that generally only one foot is primitively af-
fected, but that after the thigh of the diseased limb begins to enlarge,
then the other manifests the commencement of the disease at the
malleolus.*
When the disorder attacks the inferior region of the abdomen, the
signs which present are rather more obscure. It produces sharp
pain, much uneasiness, but without any marked character^ but the
enormous distention of the abdomen which succeeds these pains, or
the tumefactions round the verge of the anus, or of the enlargement
of labia in women, or of the scrotum in men, soon dissipate' the first
uncertainty.
The skin not being the primitive seat of the disease, is not neces-
sarily affected; thus, it sometimes presents merely a whiter appear-
ance, with a slight hardening or resistance upon pressure, (renitance,)
sometimes the subcutaneous veins are enlarged, varicose tumours
result, and the skin is of a violet colour. This tissue, however,
does sometimes present various alterations. Thus, in addition to the
erysipelatous appearance previously mentioned, vesiculous inflamma-
tion is often presented; in this case a slight effusion ensues, followed
by thin, soft, yellowish scales; in other instances appearances similar
to those of ichthyosis take place; finally, in certain circumstances,
fissures with ulcerations ensue, which become covered with thick,
yellow scales.
The lymphatic glands oftentimes are hardened and scirrhous, or
suppurate, or even become gangrenous, and frequently deep, fetid
ulcerations ensue in the limbs after their size has become enormous.
7>efl!/w?ent--Respecting the treatment, much is yet to be decided,
Biett recommends that topical depletion by leeches should be em-
ployed at the commencement of the disease, when the inflammation
of the lymphatic vessels is manifested by their redness and hardness;
the leeches should not, however, be applied directly upon the course
of the vessels, but a little on either side. In conjunction with this,
he uses emollient applications, and enjoins entire rest. In the
chronic state, (in which it is generally seen,) venesection has been
proposed, but its success does not seem to recommend it; in some
cases, indeed, it has proved positively detrimental. Rayer recom-
mends very highly, scarifications along the course of the lymphatics,
* Alibert, Dermatoses Lepreuses, p, 239,
356 Pennock on Elephantiasis.
and this is a favourite remedy of Lisfranc, who reports many cases
where the result has been very satisfactory.*
The experience of the Hopital St. Louis is, however, in favour of
a different course, and the eminent physician,t of that institution
considers that the best treatment consists in compressions, friction,
and the use of local vapour baths. Compression is made by a ban-
dage from an inch to an inch and a half in width, and applied by a
moderate force. The frictions should be made with an ointment of
hydriodate of potash in the proportion of hydriodate, Jss. to adeps,
?].; this application, however, is to be relinquished whenever an
acute inflammation supervenes. Whilst in the vapour bath, the pa-
tient should be directed to use friction upon the diseased part. As
reo-ards the amputation of the affected limb, experience is decidedly
adverse to its employment, as the disease almost invariably attacks
other members.
The internal treatment being very similar to that of the elephan-
tiasis of the Greeks, will be given in the remarks of that disease.
Elephantiasis of the Greeks. — Mr. L. a lawyer, aged twenty-eight,
born at Crepa in Alentejo, in Portugal, entered the hospital of St.
Louis in the winter of 1 832. The patient is a large, muscular man,
with black eyes and hair; his intelligence and literary acquirements
are remarkably great. He gives the following history of his case: —
His parents enjoyed good health, and had never had any cutaneous
disease. He had no serious indisposition until the sixteenth year of
his age, (1820,) when the present disease commenced by an extreme
feebleness in the ring and little finger of the left hand; he lost the
power of extending them voluntarily, they became flexed against the
palm of the hand, and it was necessary to employ the right hand
when he wished to straighten them. This loss of movement has gra-
dually increased, and he now finds it impossible to overcome the
flexion. In 1827 a discoloration of from three to four inches square,
of a light-brown colour, (cafe au lait clair,) slightly elevated, appear-
ed upon the calf of the left leg. This spot was insensible to slight
pressure, and it required a sharp blow before the patient perceived
any sensation in it. This insensibility extended over the whole limb;
and in illustration of this fact, he mentions, that being near a stove
he was severely burned, but was not aware of the injury until he ob-
served the consequent vesication.
In 1828 a small tubercle, of the size of a pea, appeared below the
* Rayer, Maladies de la Peau. Art. Elephantiasis des Arabes. f Biett.
Pennock on Elephantiasis. 357
chin, which was repeatedly cut by the patient in shaving himself:
this tubercle was followed by several others, and in 1830 the entire
face was covered. No assignable cause can be given for the produc-
tion of the present disease. The patient has never had the slightest
syphilitic symptoms, has never committed excesses of any kind, and
his situation in life has always secured to him all possible comforts.
I saw him for the first time in January of 1832, and his appear-
ance, which has been but slightly modified since, was as follows: —
The entire face was of a brownish-yellow colour, (bistre of the
painters,) the nose, eyebrows, and more especially the vicinity of
the chin, are covered with tubercles of different dimensions, varying
in size from that of a pea to a hazel-nut. The smaller tubercles are
convex; the larger flattened. When examined closely, their colour
is redder than that of the face. They are hard and incompressible.
These elevations produced a singular effect upon the physiognomy
of the patient: the beard continues to grow from among the groups
on the chin, whilst the hair of the eyebrows has fallen, and the en-
tire face is peculiar: many of the students imagine that it resembles
that of the lion. The arms are covered with spots more or less raised
above the level of the skin, some are merely perceptible to the touch,
whilst others are elevated from one to two lines. Their colour varies
from a light brown, (cafe au lait,) to that of the darkest bistre. The
skin where they exist is insensible, but in the interspaces of the ele-
vations it is remarkably white and delicate.
On the left arm, where the patient was burned, we observe slightly
depressed cicatrices of a violet colour. The skin on the hands is ex-
tremely fine and delicate, and redder than usual. The fingers of both
hands are flexed; those of the left immoveable. The patient can
feebly grasp objects for a short time with the right hand. The neck
and body are entirely free of cutaneous disease.
The inferior extremities are covered with spots analogous to those
on the arms. On the upper part of both feet are large cicatrices,
slightly depressed, of a red colour, caused by the burn of 1827, and
which frequently ulcerate; these ulcers are round, with perpendicu-
lar edges, which heal by rest and the frequent use of the vapour
bath. The general health of the patient is good, but in the spring
and autumn he has violent attacks of pain in the head; the tubercles
then increase in size, become redder, and are extremely painful
upon pressure: combined with these symptoms are — a frequent pulse,
loss of appetite, and obstinate constipation. Venesection uniformly
relieves him, whilst leeches applied to the neck produce no beneficial
eftect.
358 Pennock on Elephantiasis.
On the 15th of November, 1833, the patient experienced all the
symptoms above-mentioned attended with great prostration of strength.
Pulse 95. These were the precursors of an erysipelas of the face,
which was first observed on the following day. The face became red,
tumefied, and painful^ the tongue whiter thirst extreme. Venesection
and lemonade.
\7th. Large vesicles have formed on the cheeks, but on the lips
and chin a puriform secretion has taken place. The acute symptoms
of yesterday are slightly modified; the skin is moist and covered with
perspiration. From this time the disease rapidly declined, and at the
end often days the skin has assumed its ordinary brown tint. The
tubercles of the forehead and nose were less prominent, but the lips
and cheeks were covered with thick, dark-coloured crusts, which fell
oft* spontaneously at the end of a week.
The primitive disease of the face was evidently rendered much
better by this attack of erysipelas. The tubercles were flattened and
diminished in size, their colour became more like that of the healthy
skin; the eyes were less sunken into the orbit, and the chin not so
prominent. A circumstance connected with this attack of erysipelas,
produced a strong impression upon the medical attendants of Mr. L.
He had persuaded himself the erysipelas would prove fatal, and it
was, with feelings bordering on despair, that he found his health
would be reestablished.
Many modes of treating the disease were adopted. At the com-
mencement of 1832, M. Biett prescribed the proto-iodide of mercury;
it was gradually increased until given in the dose of three grains a
day, of which the patient took eighty pills. This treatment produced
no diminution of the tubercles, and the violent pains it caused in the
stomach, prevented any further employment of it. After this, re-
course was had to numerous vesications, of an inch and a quarter in
diameter, followed by a cauterization with per-nitrate of mercury: this
also caused intolerable pain, and was abandoned. Subsequently, the
size of the blisters was diminished to one-fourth of an inch, and the
vesicated surface was washed with a solution of nitrate of silver. The
tubercles on the cheek and chin were diminished in volume by these
applications, but this result was scarcely obtained upon one part of
the face before they reappeared upon another, rendering it very evi-
dent that the melioration was but momentary. The patient after re-
maining for several months in Paris without any very great perma-
nent amelioration, returned to Portugal in January, 1834.
i^emar/cs. •~Much obscurity has arisen from the circumstance of
two diseases so different in character as the malady of Barbadoes,
Pennock on Elephantiasis, 359
and that, of which we have just detailed an observation, being called
bv the same generic title of elephantiasis. The elephantiasis of the
Arabs is entirely distinct in its appearance and character from this
affection. It does not present the tubercles which are developed in
the skin and the subcutaneous tissue, but consists ifi an enlarge-
ment of one or more parts of the body, and especially of the legs.
The skin in elephantiasis of the Arabs, is not, as in that of the Greeks,
primitively affected.
The elephantiasis of the Greeks has been attributed to a syphi-
litic origin, but on insufficient evidence. In the case of Mr«
L. there had never been any venereal infection. Again, the ap-
pearance of syphilitic tumours are unlike in colour, in density,
and in volume. The tumours of elephantiasis are larger, softer, and
have not the copper tint. The syphilitic ulcerations have deep, per-
pendicular edges: their bases are grayish, and surrounded by a hard
cellular tissue: their form is almost circular, and unlike the super-
ficial ulcers which are situated on a soft, fungous tumour, which con-
stitutes that of the elephantiasis of the Greeks.
One of the most remarkable symptoms which attends this disease,
is the loss of sensibility in the parts affected. This has been remark-
ed by almost all pathologists who have written upon the subject, ex-
cepting Rayer, who mentions two cases in which this phenomenon
was wanting.*
A very interesting circumstance connected with the history of this
case, is the amelioration of the disease in consequence of the occur-
rence of erysipelas. M. Rayer reports an observation in which a
similar effect took place, and after repeated attacks of erysipelas, an
inveterate elephantiasis was almost entirely cured. Similar facts
have been observed by M. Biett, and with the '* view of increasing
the vitality of the affected parts at the commencement of the dis-
ease," he employs dry frictions, volatile liniments, or, what he pre-
fers, vesicatories upon the spots and tubercles. Under this plan of
treatment, several of his patients have recovered. When the disease
is more advanced, he recommends frictions with the ointment of hy-
driodate of potash, (Hydriodate potas. 9j. to Adeps, 5j.) which he
has found highly serviceable. Conjoined with these topical applica-
tions, he also employs the local vapour bath, thrown in a jet upon
the affected parts. If the disease be general, vapour baths for the en-
tire body are recommended.
When the disease has been of long duration, and the tubercles dis-
• Rayer. Maladie de la Peau. Tome Ire, pag-e &^0,
y
360 Pen nock 071 Elephantiasis.
seminated over a large surface, in addition to lotions slightly irritat-
ing, he recommends alkaline or sulphur baths. An internal treat-
ment is also demanded; he uses accordingly the sudorifics — the tinc-
ture of cantharides and the arsenical preparations. The decoction of
sarsaparilla with guaiacum, squills with a small quantity of Daphne
mazereon may be administered to the patient. His usual dose of the
tincture of cantharides is, at the commencement of its exhibition,
three drops in the morning before eating, and gradually increasing
to twenty or twenty-five. M. Biett gives, however, the preference
to the arsenical preparations. Of Fowler's solution he recommends
three or four drops a day at the commencement, gradually increasing
to twenty or thirty, but watching with great care its effects upon the
system, and regulating its administration accordingly. The experi-
ence of M. Biett, in the internal use of the different preparations of
iodine, is not yet sufficiently great to permit him to give a definite
opinion respecting their merits. Reasoning from analogy, however,
this would appear to be among the most valuable means of combating
this disease.
In India the Asiatic pills, consisting of one-thirteenth of a grain of
arsenic to nine times that quantity of black pepper, have been much
used, and cases are reported where the result has been favourable to
its employment.*
M. DE Pous has seen a cure effected by the use of the Lisbon diet
drink conjoined with squills. M. Daynac a case of cure by the use
of the hydrochlorate of gold combined with the powder of the Lyco-
podium clavatum, and applied by frictions to the tongue and gums.
Robinson has lauded very highly the Asclepias gigantea pulverized,
in combination with calomel and the antimonial powder.!
Calomel does not appear to have been much employed by the con-
tinental European practitioners, and we have very few cases report-
ed by them in which it was used. This powerful agent should not
be omitted whilst speaking of the remedies employed in the treatment
of elephantiasis. But the facts collected on the therapeutic history
of this disease are not yet sufficient, to say positively what are the
best means of combating it. M. Alibert remarks, with great truth,
*' tout est a rechercher, tout est a decouvrir dans le traitement de
cette maladie." He urges the great importance of attention to the
food and habits of the patient.
It is much to be regretted that the observations respecting this
* Rayer. Maladie de la Peau. Tome Ire, page 687.
\ Alibert. Clinique de I'Hopital St. Louis.
Pennoek on Elephantiasis. 361
disease, and those of cutaneous diseases in general, have been so
vague and unsatisfactory. Had the rigid accuracy which character-
izes the founder of '* the numerical system of observation"* been
adopted, what positive and certain results should we not have seen?
Much, however, is to be expected from that eminent physiologist, M.
Biett: and, from the great mass of facts which he has collected, this
still obscure part of medicine will probably be much elucidated.
The anatomico-pathological appearances have been reported too
vaguely to present any definite notion of the lesions which may cha-
racterize this disease.
Inflammation of the skin after recurring repeatedly on the same
part causes a tuberculous induration, having a white appearance,
and which resists the scalpel. The skin which covers these indura-
tions is generally thinner than that on healthy surfaces.
Tubercles are frequently found on the mucous surfaces of the mouth,
pharynx and larynx. In cases where the voice of the patient was much
altered, tubercles with ulcerations were invariably found in the larynx:
in one instance the arytenoid cartilages were almost entirely destroyed.
The lungs are generally tuberculous, and the peritoneum and mesentery
are also implicated in the same manner. The mucous coat of the in-
testines are reported as being almost always more or less ulcerated^
and the glands of Peyer are frequently the seat of ulceration.
. Alibert and the Baron Larrey cite cases where the bones were
found carious or spongy.
Elephantiasis Topica, (Plenck.) — Frederic, aged seven and a
half, was born in the Island of Trinidad, of a French father and In-
dian mother, both of whom enjoyed excellent healtli, and were free
of cutaneous disease. He left America at three and a half years of
age, previous to which time he had always been very healthy. His
appearance is that of a delicate child, with but little muscular deve-
lopmenti dark eyes| black hair| very intelligent, and of remarkable
quickness of perception. Shortly after his arrival in France he had
an attack of continued fever. The present disease commenced in the
month of August, 1830. The first symptom which was manifested^
was a difficulty in holding the pen in writing? the indicator of the
right hand became flexed, and the child lost the ability of extending
it voluntarily by its extensor muscles. The middle finger of the same
hand soon afterwards became also flexed, and the wrist was extreme-
ly weak. ' The power of extension of the right hand becoming more
* M. Louis.
No. XXVIIL— August, 1834. 31
362 Pennock on Elephantiasis.
and more impaired, his father took him to the springs of Neris in the
autumn of 1831, at which place he passed six weeks. It was there
that the first ulceration of the fingers took place, and caused the loss
of the nail of the indicator of the right hand: since that time the dis-
ease has made continued progress.
December 23c?, 1832, present situation. — Right hand. The arm
being in pronation, the hand and wrist falls perpendicularly by its
own weight, and the child finds it impossible to raise it, except by a
general movement of the whole arm. The action of the flexor mus-
cles, however, is unimpaired: he can bend the wrist, or grasp sub-
stances between his fingers. The different bones of the fingers are
flexed on each other, and upon those of the metacarpus. The terminal
bones of the indicator, as well as that of the third finger, have been
separated by ulceration at the joint. The nails of all the other fingers
have fallen off by ulceration, leaving surfaces more or less concave,
of a pale-red colour in the centre, dry, cracked, and resembling ul-
cerated chilblains in the process of healing. The rest of the ter-
minal extremities of the fingers are covered with a hardened skin,
which in places is also ulcerated. Beside these alterations of struc-
ture, there is an ulceration at the junction of the second and third
pha anges of the ring finger.
Left hand, — The patient can readily extend and flex this hand on
the forearm, although all the phalanges of the fingers of the second
and third row, are permanently bent on the first, and cannot be ex-
tended by their proper extensor muscles. The thumb is uninjured.
The indicator has a transversal fissure with a red base, at the
junction of the first with the second phalanx; at the other joint of the
same finger is an elliptical ulceration of the size of a small bean which
commenced fifteen days ago. — Middle finger. At the base of the nail
is a round ulceration surrounded with a yellow, indurated skin. The
terminal bone of the middle finger has fallen by ulceration, and the
rounded extremity is covered with a hard, thick skin, like that co-
vering the parts of the feet which are pressed upon in walking. There
is also a slight ulceration on a level with the articulation of the first
and second bones. The little finger is uninjured.
Right foot. — At the junction of the fifth metcitarsal with the tarsal
bone, exists an elliptical ulceration one-fourth of an inch long, with a
red base, and surrounded by a yellow skin of a hardness equal to that
of horn. Below the patella of the same leg, are seen two brown cica-
trices, which are the traces of previous ulcerations.
The sensibility of the hands is very obtuse; the child does not per-
ceive a slight touch, and does not feel unless the fingers are strongly
pressed, or picked with a sharp instrument.
Pennock on Elephantiasis. 363
None of the ulcerations have been either preceded, accompanied,
or followed bj any pain. The child is very cheerful, takes great
pleasure in his sports, and the sensibility of his diseased hands is so
obtuse that he frequently scratches up the earth with them. His
general health is excellent. Treatment — Baths for the hands every
day for an hour, in decoction of poppy-heads; infusion of hops for
drink, with nourishing and tonic diet.
Jiipril Qth. — On the right foot, behind the cicatrices previously
mentioned, a vesicle of the size of a hazle-nut made its appearance.
It is perfectly round, is formed by the elevation of the epidermis
only, and contains a serosity slightly thickened; it is not surrounded
by any traces of an inflammatory circle. The child does not suffer
any pain, and his nurse is confident that he has not been burnt. Next
day the vesicle, (bulle,) broke spontaneously, and left a superficial
ulcer of the same size with a very dry surface.
19//i. The ulceration has not extended superficially, but has in-
creased in depth. It is attended with very slight suppuration; is not
painful, its colour is a pale-red; is without granulations, and its
borders are perpendicular.
9.%th. Same state of ulcer.
May 1st. — Numerous fleshy granulations are observed at the
bottom of the ulceration; the suppuration is rather more abundant.
15th. The place of the ulceration is now indicated by a small de-
pressed surface, slightly red, where the skin is finer than the rest,
and insensible to the touch. During the spring he had frequent pa-
roxysms of spasmodic cough, which rendered it necessary to have re-
course to venesection. There did not appear to be any connexion
between this cough and the disease of the skin.
December. — The cutaneous disease has not made any progress,
Vv^ith the exception, that in the month of July, a vesicle similar to that
last mentioned, appeared on the right knee, which disappeared at the
end of three weeks. The general health of the child is excellent.
Remarks. — This variety of elephantiasis has been described by
Plenck under the appellation placed at the head of the observation.
M. Alibert remarks in his clinique, that medical travellers in India
have brought him great quantities of the nails which had spontaneous-
ly fallen off from the fingers of the persons affected with this disease.
M. Bonpland relates that the disarticulation of the joints followed by
sloughing and loss of the bones of the hand are of frequent occurrence
in South America: even the teeth fall from the alveoli as a result of
this affection.
364 Jackson 07i Belladonna in Pertussis.
Art. V. On Belladonna in Pertussis. By Samuel Jackson, M. D.
of Northumberland, Pennsylvania.
irlOW long since hooping-cough was first known, or how far it ex-
tends over the inhabitants of the earth, we must leave to men of more
recondite learning; but it seems now more than probable, that nearly
every human being from this time to the end of the world is destined
to sufter this painful malady, from which therefore there must arise
an aggregate of distress, which no finite mind can at all comprehend.
Nor is it to be included among the safe diseases, since more perish of
it by a hundred-fold than of both hydrophobia and tetanus together,
maladies which have excited far more interest, both in and out of the
profession; and if we mistake not, this mortality is to be attributed
to the fact, that physicians have hertofore done so little towards the
cure, that nine-tenths of the people never apply to them in this dis-
ease, till a fatal peripneumony supervenes, and the patient can no
longer breathe. The subjects of it too, are generally children, very
often infants at the breast, whose sufferings, above all others, we
ought to sympathize with, and endeavour to relieve.
Belladonna having been so highly extolled by various physicians in
Europe, for its antispasmodic virtues in this disease, we were there-
fore induced, in the winter of 1831, to make some experiments with
it in our own practice.
We have always been decidedly averse to the polypharmacy of
our transatlantic brethren; but in this case, wherein their experi-
ments were to be tested, it was considered as unfair to reject any
part of their combinations. The medicine was therefore given in
mixture with sulphur and ipecacuanha; and the doses of this mixture
were alternated with prussic acid, according to the method of Dr.
Kahleiss, as may be seen in Vol. VL p. 238, of this Journal.
These medicines were given day after day to several patients
without the slightest effect. We did not then advert to the fact,
that the principal remedy may be given with perfect safety even to a
child, till dilatation of the pupil takes place, or it is most certain
that we should have given it in larger doses, and for a longer time.
But ere this thought came in mind, we had thrown aside the medi-
cine with contempt, and the disease having passed away in the vi-
cinity, we had no opportunity of further experiments. Nor must it
be left unnoted, that our belladonna was afterwards found to be
utterly inert, to which circumstance we shall have occasion to revert
towards the end of this paper. But one point then appeared to be
Jackson on Belladonna in Pertussis. 365
ascertained by this experiment, that prussic acid, sulphur, and ipe-
cacuanha, which were given at the same time, made no impression
on the disease. The acid in particular, was proved to be useless,
for it was given in much larger doses than directed by Dr. Kahleiss,
because some dependence was to be placed on a medicine which had
been so often and so highly extolled both in this and other species of
cough, as well as in other spasmodic diseases. That the acid was
of good quality, we had abundant proof from other experiments.
What effect this sedative might have, if given to the very utmost
limits of safety, it is impossible to ascertain in little children, who
are unable to give a just account of their feelings^ but with respect
to belladonna, the effect on the pupil is a satisfactory index, as we
shall see in the progress of our paper.
In the subsequent December, 1832, the disease invaded our own
family, and as there were five children to go through it of various
ages, from eleven to three years, we entertained no hope of seeing
the end of our troubles for several months, and therefore we
prepared our minds for a most comfortless, and even distressing
winter.
Our second child, a girl in her ninth year, had high fever, and her
cough was so violent, that the blood streamed from her nose at al-
most every paroxysm. This too was the mere catarrhal cough that
precedes the spasmodic and more distressing form of the disease.
She was bled once, purged gently, took tartar emetic in nauseating
doses, with an abundance of linseed tea| thus the fever was soon re-
duced, and the characteristic cough began to be developed. We
then commenced with extract of belladonna, giving it simply tritu-
rated with water, in what doses we do not recollect, but it was given
freely till the pupils were greatly dilated, and her vision so confused,
that she could not read l^arge print. To reach this point, did not re-
quire more than two days, when the complaint being plainly miti-
gated, the medicine was for the present omitted. In about twenty-
four hours the pupils began to contract, and vision to become more
distinct; the belladonna was therefore resumed, and given in larger
doses than before. How long she took it, or how large were the
doses, we do not now recollect; nor is this point material to our pre-
sent purpose, as we shall treat of it particularly towards the end:
but we do very distinctly recollect that the relief was altogether un-
expected and incredible, for in a few days, certainly not more than
ten from the time she began the belladonna, the child was totally
cured. We do not presume to say, that she coughed none, but we
do say, that her fever was gone;, her appetite ravenous'; that she was
31*
366 Jackson on Belladonna in Pertussis,
able to attend to all her lessons, and that her cough, if she had any,
would have passed unnoticed in any family.
The other four children were soon attacked, and two of them with
great severity, as it regards the mere cough. They were all treated
as was the first, with the single exception of bleeding, and they all
recovered with the same facility. They had no relapses from cold,
though they all rode out frequently, and many miles too in the depth
of winter; nay, they appeared to have suffered none from either the
disease or its remedy.
The principal misfortune attending our experiments was this — that
from this time there were very few cases for further trials, the epi-
demic of the preceding year having pretty well pervaded the coun-
try. A few more cases however did present, and the medicine was
nearly as efficacious in them also, and would have proved equally so,
it is presumed, could we have ventured to give it in as large doses
as we did to our own children, who were constantly under our eyes.
About two months ago we had another very striking proof of the
correctness of this practice. Thfere now live in Selinsgrove two
brothers, Henry and George Snyder, sons of the late Governor of
Pennsylvania, both men of strong and cultivated minds. George's
children were first attacked with hooping-cough, and we recom-
mended the belladonna. It soon dilated the pupils; confused the
vision; rendered the older children unable to read; parched the in-
fant's mouth, rendering it unable to suck, hence it was abandoned
in a panic, and other medicines prescribed, we know not what.
Henry's children took the malady from George's; as these were
the only cases in that vicinity, and of course it broke out upon them
some weeks later. He used the belladonna as George had done till
some dilatation of the pupil was observed, and then finding little or
no advantage from it, he became sadly discouraged and began to in-
quire what further could be done. We then urged his resuming the
medicine, and stated our own experience — let us see then what he
wrote to me in a few days.
Selinsgrove f Jprtl2d, 1834.
Dear Sm,
The night after you left us our babe coughed very badly, and kept us up
nearly all night. In the morning I commenced with the belladonna, and gave
it to all three of the children, to the little one five drops, and with the most
prompt and happy effect. The two oldest do not cough at all through the
night, and the little one not more than once or twice at furthest. During the
day they are worse, but this is to be attributed to their running about so much.
The medicine is nearly all used, please to send some more.
Yours, H. W. SNYDER.
Jackson on Belladonna in Pertussis. 367
Selinsgrove, June lOih, 1834.
Dear Sie,
In reply to your inquiry relative to the effects of the belladonna on the
hooping-cough, I will state that about mid-winter my three children, begin-
ning- with the oldest, took the disease, and were coughing badly when I com-
menced giving the belladonna under your directions. The effect produced
after some days perseverance, was indeed astonishing. It acted like a charm.
The children all slept perfectly well throughout the night, and during the day
seidom coughed, unless they exerted themselves too much in their play, when
the excitement would bring on a mild fit of coughing. In the space of five or
six weeks from the beginning* they were entirely cured.
Very respectfully.
Your obedient servant,
H. W. SNYDER.
It certainly requires some courage to give this medicine in the most
efficacious manner, and this fact, it is presumed, will deter many from
giving it as they ought. George Snyder was frightened by the panic
of his family physician, and hence his children are still coughing,
whilst his brother Henry, who possessed some medical philosophy
himself, persevered and performed a cure many weeks ago. And
here we cannot refrain from relating our own alarm on one occasion
of giving this medicine. Early in the morning we prescribed the bel-
ladonna for four of our children, and then left home for Selinsgrove,
seven miles distant^ but while employed in this town, we began to
ruminate on what might be the consequence, and soon fell into a most
outrageous panic. We rode home with all possible precipitation,
thinking of nothing the whole way but convulsions, deliriums,
swoonings, and all the frightful effects of the narcotic poisons, but
upon our arrival all was well, though the medicine had been faithful-
ly given.
It is experience, and this alone, that can fortify us against these
fears. In delirium tremens, in tetanus, in spasmodic colic — how
tremendous must be our doses of opium if we expect to relieve pain
or procure sleep, without which the patient must die! We remember
the time when we shuddered at having prescribed ten grains of opium
in mania a potu, whereas we can now go to bed very comfortably
after having given twenty grains with orders to repeat the dose should
the patient not become drowsy in four hours. Thus, the experience
of one epidemic pertussis would render our practice easy and certain
even in cases of the tenderest infants.
If any one then shall condescend to try this method of cuHng
* That is, from the time they first took the disease.
368 Jackson on Belladonna in Pertussis.
hooping-cough, let him first remove the greater part of the inflam-
mation by bleeding, laxatives, low diet, nauseating doses of tartar
emetic, and an abundance of milk-warm linseed tea. Bleeding and
blistering may be necessary at the onset, and even in the progress,
if inflammation supervene as it is very apt to do upon weak or un-
sound lungs. Leeching or cupping may often be more suitable, nor
can it require much medical acumen to determine on this point. But
many cases will occur in which the belladonna may be given almost
from the first, at the same time that the above-mentioned antiphlo-
gistics are in use.
The next point is to ascertain whether your medicine is really bel-
ladonna, or some vile imposition. A year ago we sent to a friend in
Philadelphia to procure us an ounce of belladonna, and one of hyos-
ciamus. He did not go whither he was directed to procure them,
and thus it happened that both parcels were nothing but hyosciamus.
Our olfactory organs are remarkably obtuse, and hence, upon first
smelling one bottle, and then the next, the deception was not appa-
rent. Well I we applied some of this supposed belladonna to a gen-
tleman's eye for the purpose of tearing open the pupil, contracted by
an iritis, but it was all in vain — no effect was produced on the eye,
but a sad disappointment and vexation on the poor gentleman's
mind.
But suppose the medicine be actually extract of belladonna, it is
two chances to one if it be active. What I first used in 1831, as
above related, was utterly worthless, though just obtained from a
very careful apothecary in Philadelphia; the parcel that George Sny-
der first used, he obtained from Harrisburg, and it too was inert. In
Europe it would appear, that the powdered leaves and root are more
in use, and since extracts are too often fallacious, it would be well if
that respectable body of men, the physicians in Philadelphia, would
take care that the apothecaries provide those more certain prepara-
tions. We made several efforts to obtain them, but was answered
that they were not known in the shops of Philadelphia.
Suppose then, that you are provided with the extract; dissolve one
grain in a drachm of cold water, and let fall a few drops into some
idle person's eye; if it dilate the pupil, and confuse the vision very
seriously for twenty-four hours, the medicine is good. But it would
be well to try it still further, by giving it to another person inter-
nally; if to an adult, in doses of three grains every two hours, till the
effect is produced, or the medicine proved to be inert. It was by
applying it to our own eyes, that we ascertained the utter worthless-
ness of that which first deceived us in 1831, but this was after all
Jackson on Belladonna in Pertussis. 369
opportunity of using a better parcel had passed away for that year.
\^'hen our own child was attacked in 1832, we found a portion of
the medicine which had been in the house for several years, and had
therefore been supposed to be inert, but upon dropping a solution
into our own eyes, it was quickly ascertained to be good.
Suppose then, that the system is well prepared for the belladonna,
and that you have some which is certainly of good quality; let the
extract be triturated with water, to which, in order to prevent fer-
mentation, add a suitable proportion of proof spirit; give this to a
child three months old in such doses every three hours, from sunrise
till bed-time; that each dose shall contain one-sixth of a grain of the
extract; to a child of two years old a full grain may be given; to one
four years a grain and a half, and from these data the medium dose
for any age can be easily ascertained. But with respect to the dose,
it is certain that we know but little, as our experience has been very
limited, and the strength of extracts is very uncertain.
The effects 09 the system must be carefully watched, and as soon
as dilatation of the pupil takes place, the medicine must either be
omitted altogether, or given in much smaller doses. We consider it
as far the safest to give no more until we may be satisfied that the
effects of the first exhibition are beginning to pass off". The reason
of this is too evident to the regular practitioner, and others must
take the fact, if they are not capable of the reasoning.
As soon as the system begins to rise from under its influence,
which may be known in the infant by the state of the pupil, let it be
resumed, and given in larger doses than before, so as to make a
strong impression. It is now that its powers become apparent, but
the dose must be increased, for, like conium, its effects on the sys-
tem diminish most wonderfully in proportion to the doses administer-
ed. The disease will now begin to yield, and how much longer the
medicine is to be continued, or what coadjuvants may or ought to be
used, let every judicious physician determine for himself, when the
case with all its necessities are before him. We are not writing a
treatise on the subject of pertussis, but merely endeavouring to show
the great and almost incredible power of a single medicine therein.
It is a great comfort in the free use of this narcotic, that a harm-
less dilatation of the pupil will probably always give us timely notice
of the approaching subduction of the system, for, freely as we have
given it, there was no other unpleasant effect observed, unless the
confusion of vision. Even the eruption which has been supposed to
be prophylactic in scarlatina, was not produced in any of these cases.
It is true, Mr. George Snyder thought it produced a dryness of the
370 Jackson on Belladonna in Pertussis.
fauces, which prevented his child of two or three months old from
sucking, and this is very probable, as this effect has been commonly
observed from an over-dose of the medicine. But we do not recol-
lect that any of our patients were thus distressed, and therefore it
seems probable that the child was over-dosed, or perhaps had fever,
which predisposed it to be thus irritated and parched. But this dry-
ness may surely be overcome by the constant use of some cold, aci-
dulated mucilage. Henry Snyder's child, six months old, as above
related by himself, was almost cured of the most violent grade of
the cough in a few days, but no such dryness was noticed.
Such then is the easy victory which we are likely to obtain over
this once frightful disease, and for this we are indebted to the genius
and industry of Germany. We believe that the belladonna has been
seldom used to any good purpose in pertussis by our American phy-
sicians. There is only one case reported by them in the whole mass
of this Journal — that by Dr. Yalk, Vol. VII. page 417 — which is
very satisfactory. Professor Chapman speaks of it with very little
respect in the 5th edition of his Therapeutics, and Professor Eberle,
in his Materia Medica, gives it credit for benefiting only two cases
out of twelve. He adds, however, for our comfort, that he "appre-
hended the extract he employed was not very good." Let us, then,
in the midst of these doubts and discrepancies, implore those persons
who may be hereafter disposed to repeat our experiments- — 1, to be
certain that their medicine is active; 2, that they give it freely; 3,
that they do not rest satisfied with an imperfect trial, always remem-
bering that they may deceive themselves, and also be deceived by
others. Their first experiments ought to be made among honest, in-
telligent people, or at least among such as they have known to' be
faithful. They ought to remember that to cure a disease, does not
consist in giving a certain popular medicine therein, but it is to pro-
duce on the morbid system a certain catenation of effects, which the
learned experience of the physician supposes to be necessary or con-
ducive to the end in view. If these effects do not become visible, his
labour is lost, his patient not cured, and the remedy condemned.
All men of learning must acknowledge this, yet all our systems of
Materia Medica are written precisely as they would have been, had
they been attempted by Podalirius or Machaon; they deal largely
in the application of medicines to various diseases, but the indications
to be fulfilled, and the effects to be produced on the system, are
rarely considered.
In the present case, the premises, the reasoning, and the conclu-
sion, are all within a very narrow compass. The mere symptomato-
Jackson on Belladonna in Pertussis. 371
logy of hooping-cough has long and justly ranked it among spasmodic
diseases; hence it was only required to ascertain what medicine
might subdue the spasms without superinducing other and worse irri-
tations. Assafoetida has long been used with some advantage, but it
is feeble, and hardly worthy of notice; opium is the most powerful of
all the antispasmodics in common use, but if given early in the dis-
ease, it irritates and brings on fever; prussic acid and digitalis have
both been used with some advantage, but were they even as powerful
as belladonna, we are doubtful concerning their adaptation to general
use. There are no means of knowing, as in belladonna, when we
have carried them to their utmost verge of safety in little children.
Stramonium has been used it is said with success, which is very pro-
bable, since it possesses most of the properties of belladonna. It,
too, will dilate the pupil, and give timely warning of danger.
It is a favourite opinion of the present writer, that too little atten-
tion has been given to that class of medicines which are directly se-
dative. Who could have anticipated that in ten-grain doses of tartar
emetic, a sedative and a cure would be found for peripneumony? or
who could have believed that swimming across the Thames in the de-
lirium of pestis, would have carried off the whole disease? That di-
rect sedatives are within our power, and that they bring this hitherto
wayward disease within the grasp of the humblest capacity, is cer-
tain; and since physicians have thus ascertained the nature of the
disease, and the indications of cure, not from preconceived theories,
mere idola specus, but from multiplied experience through many ge-
nerations, it is fondly to be hoped that even better medicines than
belladonna may yet be discovered. The acetated preparations of
opium, as the acetate of morphia and the acid tincture of denarco-
tized opium, we have found to be much more safe and useful in this
disease than common laudanum, and this we anticipated from the
fact that they are far less apt to bring on costiveness, or to obstruct
expectoration. They may, no doubt, be often given with great ad-
vantage towards the close of the disease.
There is, however, a still more promising method of using opium,
for which we may refer to Vol. V. p. 501, of this Journal. Draw a
blister on the epigastric region, remove the epidermis, and dust over
it a half-grain of morphium mixed with a little starch. Renew the
application every evening, and renew the blister also when the first
dries up. Dr. Meyer, ofMinden, relates that he thus cured five
violent cases in eight days, and without using any other remedy than
a single emetic in each case. Here, then, if we mistake not, is a
very plausible remedy, but surely it would be much more physiolo-
372 Parrish's Case of Ununited Fracture.
gical to apply the blister to the back, where it is known to operate
more powerfully on the substance of the lungs, as well as more di-
rectly on the centre of nervous influence.
The question then is — not whether hooping-cough be a curable
disease, but which is the most eligible of all the curative means
within our reach. Surely those physicians who may first have an op-
portunity of contending with it in the epidemic form, will not neglect
to settle tliis question by multiplied experiments and indubitable
testimony. At present we fear that all is uncertain, and even incre-
dible, unless to those who have seen with their own eyes, and there-
fore, in the favourite language of Bacon, " we note the subject as
wanting."
Northumberland, June 7th, 1834.
Art. VI. Case of Ununited Fracture, successfully treated by Fric^
lion. By Isaac Parrish, M. D. one of the Surgeons to the Wills'
Hospital for the Relief of the Lame and Blind.
olNCE the principle of exciting inflammation in the surfaces of
fractured portions of bone, has been so successfully illustrated by
our distinguished countryman. Dr. Physick, the subject of ununited
fracture has received a large share of attention from surgeons both in
this country and abroad. Several other methods of practice, besides
the introduction of the seton, the plan originally proposed, have been
supposed to be adapted to particular cases, and have been success-
fully executed.
The following case exhibits a rare instance of the practicability of
effecting the process of agglutination without a resort to the knife or
the seton, but simply by trituration of the fractured surfaces of the
ununited bone upon each other. This practice would perhaps prove
effectual only in a few instancesj in the present case several circum-
stances concurred to render the result peculiarly favourable. — First.
The humerus being the seat of fracture. Secondly. The unusual
obliquity of the fractured surfaces. Thirdly. The excessive wasting
and loss of muscular power in the limb. Fourthly. The robust state
of the patient's constitution and his temperate habits.
Case. — Samuel Sapp, a stout, athletic man, aged about twenty-
seven years, from New Jersey, applied to my father, during the last
summer, concerning an ununited fracture of the humerus. He stated
Parrish^s Case of Ununited Fracture. 373
that on the 1st of March, 1833, while engaged in his occupation, as
one of the deck-hands on board the steam-boat Trenton, he was
dragged overboard by becoming entangled in the rope, and in at*
tempting to save himself by seizing the railings, his left arm was
fractured.
He immediately applied to a surgeon in a neighbouring town, who
carefully adjusted the fragments, and placed the limb in splints; the
injured parts being but slightly painful, the first dressings were al-
lowed to remain undisturbed for about three weeks, when other^
splints were substituted, and continued on the limb, with occa-
sional alterations, for three months. At the end of this period, find-
ing no improvement, his physician advised him to seek further ad-
vice.
On removing the splints, the limb was found to be much reduced
in size, its muscular power was obliterated, and its capillary circu-
lation feeble. He was advised to lay aside the splints and bandages,
to use the limb moderately, and to keep up a steady system of ex-
ternal frictions, and requested to return to the city in cool weather.
On his return in the autumn, no improvement was manifest; and
by the advice of my father, he placed himself under the care of my
friend. Dr. William Ashmead, and myself.
On a careful examination of the parts, we found an unusual obli-
quity in the fractured portions, the surfaces exposed being not less
than three inches in extent, the edges of these surfaces, the rounded
extremities of the fragments, and the crevice separating the opposing
surfaces of the fracture, could be distinctly traced by the fingers.
This examination was rendered peculiarly satisfactory, in conse^
quence of the emaciation and flaccidity of the limb.
Owing to the remarkable extent of the fracture, and the loss of
muscular power in the arm, the fragments, which in a more vigorous
state of the surrounding parts, might have been kept in apposition,
were separated from each other to a greater or less extent, as they
were influenced by the position of the limb. When the forearm was
flexed upon the arm, in the usual attitude for fractured humerus, the
surfaces of the fragments were separated throughout their whole ex-
tent, but more particularly at their upper portion— and it was only
in one position that their apposition was eftected.
The limb being placed in that position, which we found upon trial
effected a perfect coaptation of the parts, the upper and lower por-
tions of the broken bone were grasped by the hands, and a firm, glid*
ing motion communicated, so that the surfaces could be felt rubbing
upon each other. This process was continued for several minutesj
No. XXYIIL— August, 1834. Q2
374 Huston's Case of Hypertrophy of the Mammde,
and the limb was then secured in this position bj light dressings in
an angular box — a piece of thin board being firmly bound over the
seat of fracture.
This process was repeated for several successive mornings, and
was performed by Dr. Ashmead or myself: the few first trials excited
but little sensation in the fractured surfaces, though the force used
was as great as we could command. In a few days, however, the
patient began to feel pain, which increased at every repetition of the
process, until it became acute. The fractured ends were less movea-
ble, heat and action were reestablished in the limb, and we were
obliged to diminish the frequency and severity of the friction.
In about a month, bony union became evident at the lower extre-
mity of the fracture, which proceeded rapidly, and so agglutinated
the lower portion as to prevent the necessity of the box: shooting
pains were frequently experienced in the limb, and any attempt to
disturb it produced considerable suffering. Under these circum-
stances we declined interfering with the salutary operations of na-
ture, which proceeded most happily. In about two months after the
commencement of the practice, we had the satisfaction of observing
that a firm bed of callous was thrown out over the whole surface
of this extensive fracture.
The muscles soon acquired their accustomed volume and force,
and the man has since been pursuing his laborious occupation.
Philadelphia^ 4th Mo. 1834.
Art. VII. .4f Case of Hypertrophy of the Mammas. By S. C. Huston,
M. D. Resident Physician in the Philadelphia Alms-house.
At the solicitation of my friends I am induced to publish the follow-
ing case which fell under my personal charge. Even should no prac-
tical results accrue from its publication, to the scientific observer it
will still be interesting as affording a curious instance of inordinate
organic development.
Charlotte Russel, a coloured girl, had from early life been an in-
mate of the Philadelphia Alms-house. Of her early history nothing
worth commemorating is related prior to the age of puberty. At this
critical period when nature institutes a new series of actions in the
system, and all the vital forces are augmented, the customary changes
are represented to have taken place. Her left breast, however, was
observed disproportionately to enlarge, and at the time of her removal,
Huston's Case of Hypertrophy of the Mammse, 375
four months after she had completed her fourteenth year, had attain-
ed a formidable size.
Its unusual magnitude
attracted the notice,
and became a ground
of objection on the part
of the gentleman in
whose service she was
about to engage. It
was urged, however,
by the physicians of
the house, that this
mammoth production
would dwindle to its V..- 1|/ /I/a
ordinary size as she ad- ¥' .^ W i w
vanced in years, and
the rest of the body be-
came more matured.
With this "quietus"
from the medical staff*,
she was admitted as a
domestic into the fa-
mily of Mr. Henry
Miller. But as if all
the energies of her sys-
tem had been concen-
trated in the mammse,
their unnatural deve-
lopment continued to be steadily progressive until about six months
since, when from some inexplicable cause, both breasts seem to have
received a new resistless impulse, and rapidly to have enlarged to
their present enormous dimensions. To obviate the inconvenience
of such a ponderous mass, a laced-jacket was constantly worn, but
the incumbrance did not in any degree disable her from the per-
formance of her ordinary domestic duties. Her activity was even
remarkable^ she could with the greatest facility climb a tree, or
engage in the sportive gambols of youth. Her general health ap-
pears to have suffered but little derangement from her peculiar
formation; we have no evidence, however, that she had men-
struated more than once, and then it is represented to have been
but scanty in quantity. Be this as it may, on Friday, April 14th,
she was admitted as a patient into one of the wards of this house. At
the time of her admission shehad just completed her sixteenth year. On
examining the mammse a large superficial slough was discovered, oc-
376 Huston's Case of Hypertrophy of the Mammse.
cupying the most depending part of the left breast — the result of a
recent contusion. She appeared to be suffering excruciating pain.
Her tongue was furred; her bowels constipated; the surface of the
mammae hot; and the pulse evinced considerable febrile irritation.
To relieve these indications the appropriate remedies were employed.
Tuesday^ I8th. — Patient still complained of intense suffering. The
whole surface of the mammae now exhibited a disposition to sphace-
late. Hectic fever became established — at times she was delirious,
and her strength was fast ebbing away. Under such circumstances
no treatment could be instituted with any prospect of radical relief.
All that could be done was to temporize as long as possible, to sus-
tain her declining strength and mitigate her sufferings by the exhibi-
tion of narcotics. In this hopeless state she continued to languish
till the 22d, when she expired.
.^M/Ojosy.— Externally the mammae presented the appearance of two
large oviform masses, rising above the clavicle, and extending below
the umbilicus. No traces of the nipple could be detected, having
been completely embedded by the enormous distention of the parietes
of the mammae. On measuring each breast, the dimensions were as-
certained to be as follows: —
Bight breast. — Greatest circumference - - 34 inches.
Lesser do. - - - 18 do.
Weight 12 lbs.
Left breast. — Greatest circumference « - 42 inches.
Lesser do. - , , 26 do.
Weight . - , - - 20 lbs.
On removing the right breast and exposing its interior, instead of
a mass of disease or an accumulation of fluid, (as a superficial ex-
amination might have induced the belief,) it proved to be a mere hy-
pertrophy of the organ unconnected with structural disease. The
adipose and cellular tissues as well as the whole glandular apparatus
were enormously enlarged, but no appearance of disease or exudation
of fluid were perceptible. In short, a healthy structure was found,
whose only anomaly was its mammoth proportions.
On examining the organs of generation, the ovaria were found to
be larger than natural, and apparently diseased. The uterus did not
exceed the ordinary size of females at her age, but two-thirds of its
inner surface was coated with a dense covering of coagulable lymph.
The muscular system was moderately developed. The inferior ex-
tremities, from the constant effort necessary to sustain so great a
burden, exhibited considerable muscular firmness. The upper extremi-
ties, however, were somewhat emaciated and relaxed in fibre. In stature
she was about five feet--'the medium size, perhaps, of girls at her age.
Keckeley on Cholera at Folly Island, 377
i?6mflrA:s.— In reviewing the case, one fact strikes us with consi-
derable force, viz. — that this surprising development of the mammae
was not effected at the expense of any particular organ. It might rea-
dily have been supposed that the incessant demand on the animal
economy for the growth and maintenance of such an enormous mass
would in some way have retarded the development of the rest of the
body. On the contrary,. notwithstanding this irregular determination
of the nutritive elements of the body, each organ seems to have re-
ceived its full and legitimate supply. The uterus, whose sympathies
are most intimately associated with the mammge, does not appear to
have suifered any diminution of its ordinary size from this connexion.
Its functional derangement is perhaps explicable, from the fact, that
the ovaria were diseased, and two-thirds of the secreting surface of
the uterus were clogged with an exudation of coagulable lymph.
But for the early termination of this case, we might perhaps have
been enabled to add an account of the successful extirpation of the
mammae. Diseased masses of nearly equal weight and dimensions
have been removed without impairing the health or engendering a
single bad symptom. From the healthy structure of these tumours,
there is every reason to believe an operation would have been crown-
ed with success, had an opportunity been presented before the sur-
face of the mammae had begun to ulcerate, or the constitution of the
patient been shattered by disease.
Art. VIII. An Endeavour to show that the Cholera^ tvhich existed
on Folly Island, near Charleston, neither Arose from nor was Pro-
pagated by Means of Contagion. By E. C. Keckeley, M. D. of
Charleston, S. C.
i. HE brig Amelia, Captain Dickinson, sailed from New York on
the 19th of October, 1832, bound to New Orleans, with one hundred
and odd passengers, of which number three or four only were cabin-
passengers, the remainder steerage. The voyage was boisterous in the
extreme, and they were much confined below. After being at sea six
days, cholera broke out among the steerage passengers. The captain
put in into Five-fathom Hole, intending to come into port on account of
the leaky condition of the brig; but some accident happening to the
cable, he was compelled again to put to sea. In crossing the bar the
brig thumped several times severely, and caused the leak to increase
to such a degree, that it was deemed necessary to run her ashore on
the beach of Folly Island, to save the lives of the crew and passen-
gers. This occurred on the 31st of October, 1832. From the com-
mencement of the disease up to this period twenty-four persons had
32*
378 Keckeley on Cholera at Folly Island,
died, and several remained sick. When the brig grounded, there were
six feet water in her hold. The captain and one of the passengers who
visited the city authorities, described the condition of the wrecked
as one of *' pitiable destitution and distress, and as calling for imme-
diate relief." In consequence of this report, blankets, tents, and ne-
cessaries, were sent down. Dr. Elfe, the deputy port-physician,
visited the island, prescribed for the sick, and announced the nature
of the disease on his return to the city.
A boat's crew of wreckers, who had gone down for the purpose of
saving the vessel and cargo, having returned to the city, one of them
was seized with cholera, and died in Elliott street, one among the
most favourable places for the spread of a contagious malady. During
this man's illness, he was visited by hundreds of persons, all of whom
contagion took compassion on and spared, or who enjoyed the insus-
ceptibility spoken of by the contagionists. The rest of the crew were,
ordered back to the island, and having embarked, two fell sick, and
one died on the passage down.
" The wreckers were reported to have been of exceedingly intem-
perate and dissolute habits, and to have provoked the disease by their
imprudence, exposure, and intoxication."*
*' The case which terminated in Elliott street was brought on by
extreme intemperance and sleeping in wet clothes, in addition to in-
haling the foul air of the brig."t
Two physicians, Drs. Jervey and Pritchard, were in the mean-
time sent down to afford the requisite medical attendance upon the
sick. These two gentlemen having been worn down by the severity
of their labours, were relieved by Dr. Hunt, after the lapse of a
week. They, however, remained on the island until the total extinc-
tion of the disease, free from all complaint except bodily fatigue.
As neither the brig's crew and passengers, nor the wreckers, an
additional number of whom had now gone down by permission of the
authorities, were willing to remain on the island under quarantine
restrictions, eighteen men were detailed from the city guard, under
the command of a lieutenant, to perform the duty of a cordon sani-
taire. These men were stationed about one hundred and fifty yards
from the sick, but in going to and from the landing, they were forced
to pass much nearer one of the buildings used as a hospital,* nor was
it possible to prevent their communicating with the passengers who
were dispersed over the island.
The intendant, in his Proclamation, dated November 9th, says,
" a portion of the guard have become so dissatisfied knd disaffected,
as to have formed a resolution to quit the island." " Notwithstand-
* Intendant's Proclatnation to the Citizens. f Report of Board of Health.
Keckeley on Cholera at Folly Island. 379
ing the guard were forbidden to leave their posts, they removed to
the other end of the island, and left it unprotected." '* The anxiety
of the crew and passengers to get off was so great, that it was feared
that desperate measures would be resorted to."*
Of four negroes, the only persons left on the island by its proprie-
tor, Mr. Milne, three died, one a child and two adults. Of the
wreckers eight died. Of the guard employed on duty, every man was
reported to have been more or less affected with symptoms of cho-
lera, with the exception of the commanding officer^ nine were report-
ed as seriously attacked, and one died. On the 8th of November the
wreck was burnt. On the 10th Dr. Hunt's nurse, who, the week
previous, had diligently attended on the man who died in Elliott
street, died. After the 17th no more cases were reported, the weather
about that time becoming remarkably cool. On the 19th the surviv-
ing passengers took passage in the Cicero for a southern port. They
were twice afterwards shipwrecked — once on the Bahamas, and once
on Walker's Key, Florida, in neither of which instances did cholera
show itself.
The preceding is a brief history of cholera from the time it first
appeared on board the Amelia at sea, to its total extinction on Folly
Island. By some it has been supposed to favour the belief of the con-
tagiousness of that disease. I will now endeavour to show that it
does not, and that every portion of it may be explained without the
aid of contagion.
That I may not be misunderstood, it is proper that I should ex-
plain what I mean by contagion. Whenever, during the continuance
of a disease, a deleterious agent is secreted by the patient's body,
which, when brought to act on a healthy individual, will produce a
disease specifically similar to the one from which it derives its origin |
such agent is called contagion, and the disease with which the patient
is affected, is termed a contagious disease. Infection, the variety
which has been denominated idio-miasma, is generated by the decom-
position of the natural exhalations and excretions of the human body
in a state either of health or of disease. If strict attention be paid to
the cleanliness both of persons and of things, and if free ventilation
is enjoyed, idio-miasma will never exist in any place. It is always
the result of inattention to cleanliness and ventilation. That cholera
has been, and may be produced by infection, I freely admit| that it
has ever been produced by contagion, I deny.
The portion of the passengers of the Amelia, among whom cholera
first appeared, were predisposed to it before they left New York. It
is a fact, that previous to, and during the invasion of any place by
* Intendant's Proclamation.
380 Keckeley on Cholera at Folly Island,
the disease, the inhabitants generally are, to a greater or less degree,
aiFected with '* cholerine."* In proportion to the severity and obsti-
nacy of the symptoms constituting cholerine, so is the predisposition
to cholera greater or less. It is undeniable, that the classt to which
the steerage passengers belonged are always the first victims of cho-
lera. This need not be wondered at, when their habits and other
circumstances are taken into consideration. Some of the passengers
had the disease before sailing. If a predisposition was laid in New
York, and every thing warrants such a conclusion, it requires no
stretch of the imagination to discover why cholera made its appear-
ance on board the brig. From the tempestuousness of the voyage,
the passengers were much confined below. The voyage was un-
usually long; hence arose the ill-ventilation and filth. To these may
be added bad diet.J It cannot be doubted, that the most influential
of the causes of cholera, mental anxiety, was also present. These
acting upon the predisposition, excited it into action, and cholera
was produced.
I consider the remaining part of the voyage as a strong argument
against the existence of contagion. Although every circumstance
which was requisite to render contagion active was present, yet only
twenty-four died in seven days. Although more than one hundred
persons were confined in the hold of the brig surrounded by the
diseased, and although no eftbrts were, or could be made to arrest
the progress of the malady, only a comparatively small number died.
Was a better opportunity ever afforded for the extension of a conta-
gious disease? I suppose the argument of '' insusceptibility" will be
offered in explanation. It would be much better to suppose that the
disease, true to its character, selected its victims, or that contagion
had nothing to do in the matter.
The cause of cholera among the wreckers has already been pointed
out. They were '* of exceedingly intemperate and dissolute habits,
and provoked the disease by their imprudence, exposure, and in-
toxication." " The case which occurred in Elliott street, was brought
* In this city, during- the month of July, 1832, sixty-eight cases of common
cholera morbus were reported by less than twenty-eight physicians. — fJournal
Medical Society. J Affections of the bowels continued to prevail till winter.
Persons who previously had been in the habit of eating the most indigestible
articles without any bad effects resulting, could no longer do so. Whence arose
this state of things? Several cases occurred which very much resembled
Asiatic cholera. Was it possible for contagion, which, according to the con-
tagionists, existed in great abundance in New York at the time, to extend its
baneful influence across the Atlantic to this city? Causa latet, vis est notissima.
■\ Emigrants. Irishmen who were going to work on the Levee at New Or-
leans.
4 Principally Irish potatoes.
Keckeley on Cholera at Folly Island. 381
on by extreme intemperance, and sleeping in wet clothes, in addition
to inhaling the foul air of the brig." By the phrase '' foul air," it
must not be supposed that a contagious atmosphere, or an atmosphere
loaded with contagion, is meant. The air of the brig was rendered
" foul" by the number of persons who had been crowded together in
her, and by filthiness. The air may have been loaded with idio-
miasma, because every thing concurred to produce it, and in this
way I account for the almost instantaneous attack of the wreckers
after going on board. It may be asked, why was cholera produced,
and not any other disease? I answer, because there was a predispo-
sition to that particular form of disease. It cannot be denied, that
those whose digestive apparatus is most deranged are most liable to
become affected with cholera, and vice versa. Intemperance deranges
the organs of digestion to an extreme degree. These in the wreckers
being more disposed to disease than any other portion of their bodies,
became affected by the causes which were present, and yielded to
their influence. In all probability they might have escaped, had thej
laid aside their evil practices. They continued to be intemperate,
and exposed themselves more than they had for some time been ac-
customed to do. These added to the causes already noticed, called
the predisposition into action, and cholera was the result.
It is unnecessary to notice the remaining part of the history in de-
tail. If I have shown that cholera was neither produced nor con-
tinued by contagion, so far as I have gone, it is established that it
did not afterwards extend itself by that means. A disease which
does not extend itself by contagion at one time, when all things are fa-
vourable, cannot do so at another time, when things are less favourable.
The remaining cases which occurred, may be divided into two
classes. The first class includes all those persons who were attacked
after having gone on board the brig. I have already shown that
causes sufficient for the production of cholera existed in her. It is
necessary to seek out the predisposing causes. A considerable de-
gree of anxiety was manifested by all to leave the island. The guard
were so disattected and dissatisfied, that, contrary to positive orders,
they left their post, and went to another part of the island, leaving it
unguarded. This was the reason why the intendant called upon the citi-
zens to assist in guarding all points of the city where persons coming
from the island might land. This was the reason why the citizens were
called upon to be on the alert, and to impale upon their bayonets the
monster contagion, if it should attempt an ingress into our city. The in-
tendant feared that desperate measures would be resorted to by the
crew and passengers of the Amelia, and some others on the island,
such was their anxiety to be freed from quarantine. Many were suf-
382 Finley on Lithotomy,
fering from hope deferred. Many had lost friends and relatives.
Disease and death in its most terrible forms, stared all in the face.
These were the causes which predisposed, and as soon as exciting
causes were applied, disease was manifested.
The second class comprehends all those who were attacked, but
who did not visit the brig. The predisposing causes have been al-
ready mentioned. I will here state two facts, which could not pro-
perly be noticed elsewhere. It was with difficulty that persons could
be obtained to bury the dead, and when this last favour was per-
formed, it was done very slightly, ' May not the latter circumstance
have had some influence in keeping up the disease? The greater
portion of those on the island were lodged in tents. This fact is of
some importance, if it be remembered that the sea air is highly in-
jurious during autumn, from its dampness and chilliness.
The predisposing causes being known, it is necessary to look for
the exciting. In the present instance, there is but one exciting cause,
idio-miasma. It may be, that there were others, but they are not
known. From the very nature of things, the formation of idio-miasma
could not be prevented. Nurses were wanting, and cleanliness could
not be observed. I am borne out in my opinion by the fact, that the
disease declined, and ceased altogether, as soon as the weather be-
came cool. The predisposing and the exciting causes being known,
there is no difficulty in discovering why persons became alFected, al-
though they did not visit the brig, the fons et origo mali.
Charleston^ May 9.5th, 1834.
Art. IX. Bemarks on Lithotomy, By C. R. Finley, M. D. Sur-
geon U. S. Army.
U NTIL the operation of lithotrity shall have reached that degree of
perfection which will cause it entirely to supersede lithotomy, any sug-
gestions which may have a tendency to alleviate the suffering, or di-
minish the fatality attendant on the last-mentioned operation, are
entitled to the attention of the profession. With those objects in
view, the following brief remarks on the present mode of preparing
a patient for the knife, and the treatment subsequent to the opera-
tion, are respectfully submitted.
We are directed, and I believe it is a direction generally, if not
universally given in the schools, to compel the patient to retain his
urine for several hours previous to the operation, that the bladder
may be properly distended^ and in order to insure this result, we are
told to pass a ligature round the prepuce, and place the patient in
Y'm\ty on Lithotomy. 383
charge of an attendant to prevent its removal. Under such treat-
ment, w^hat must be the state of the patient when placed on the
table? Will not his system be deranged bj febrile excitement and
nervous irritability, and his bladder, especially that part immediately
concerned in the operation, in a state of high irritation, and if not
inflamed, wanting only the application of the knife or gorget, together
with the passage of the urine over the recently-divided parts to pro-
duce that state of inflammation so justly to be dreaded? Now, sup-
pose, instead of compelling the miserable patient to retain his urine,
which is a task peculiarly diflicult and distressing to the calculous
patient, and rendered doubly so to him through the terror excited by
the approaching operation, we were to produce the proper degree of
distention by injecting a bland mucilagious liquid into the bladder
after the patient is laid on the table, would not the ill eff'ects above-
mentioned be avoided?
With regard to the after treatment, I would inquire why, in the
lateral operation, (to which only these remarks are intended to apply,)
the patient being laid on the sound side, the catheter passed through
the urethra into the bladder, and permitted to remain there, the
wound may not be closed and healed as far as practicable by the
first intention? an event which would be much facilitated by the use
of the mucilaginous injection, as the distending fluid, instead of
urine — infiltration of urine, from the necessity of enlarging the inci-
sion in the bladder, would be much less likely to occur. To protect
the edges of the wound from the roughness of the calculus, should be
another important consideration; otherwise, an incised may be con-
verted into a lacerated wound. This, in the majority of cases, may
be effected by the use of an instrument invented, I think, by Dr.
Gibson, Professor of Surgery in the University of Pennsylvania; it
consists of a small sac, attached to a handle of six or eight inches
in length; the mouth of the sack is composed of a firm, elastic sub-
stance, which can be expanded or contracted at pleasure, by a simple
mechanical contrivance in the handle. The sac, in a state of con-
traction, may be introduced through the wound into the bladder,
then the mouth being permitted to expand, it may be used as a scoop
if it is found necessary to break the stone, or the calculus being
seized by the forceps may be placed within the sac, and the mouth
being thus closed, the instrument may be withdrawn, presenting only
the soft texture of the bag to the edges of the wound. It is supposed,
that by adopting the above measures, inflammation of the bladder and
of the peritoneum, the most fruitful sources of the fatality consequent
to this operation, will be in a great measure prevented.
384 Harris's Cases of Neuralgia.
Art. X. Cases of Neuralgia^ treated by Galvanism. Bj Thomas
Harris, M. D. Surgeon U. S. Navy, and one of the Surgeons of
the Pennsylvania Hospital.*
Dear doctor— Agreeably to your wish, I send to you a brief
statement of the cases of neuralgia which I placed under galvanic
treatment.
In June, 1831, I was requested to visit Mr. J. L. aged thirty-
eight, affected with epilepsy of several months continuance. His pa-
roxysms occurred daily, were very violent, and were accompanied
with such nervous irritability, that he could not endure without com-
plaint the noise of walking across the room. For several years previ-
ously to his epileptic attack, he complained of constant pain in his
head: this pain, which appeared neuralgic in its character, continued
with little intermission, and was particularly violent when I was first
consulted.
After making myself acquainted with the treatment which had
been pursued in his case, and finding that all the usual remedies had
been used without benefit, I determined to try the galvanic apparatus
of MANSFORD.t
After this had been applied a few days, the nervous irritation and
neuralgic pains began to diminish, tWough no perceptible impression
appeared to be made on his epilepsy. After the expiration of two
weeks his neuralgic pain ceased entirely, and his epileptic paroxysms
became much less frequent and violent. The weather being warm,
the meat became so speedily offensive that he begged me to discon-
tinue its use. Though the instrument did not cure the disease for
which it was particularly applied, yet it entirely relieved the patient
of the neuralgia.
This unexpected result determined me to make another trial of its
utility in the next case of neuralgia that came under my treatment.
In July, 1832, I was consulted by Dr. Otto, in the case of Master
J. S. aged eleven years, who had been afflicted with violent neural-
gia of his head. The paroxysms always occurred at night when in
bed, and continued with increasing violence for eleven months. In
the day-time he complained of great lassitude, and was always de-
pressed in spirits.
* This Article ought to have immediately followed Dr. Chapman's, (see Art. I.)
but was not received in time. — Ed.
f For Mansford's dU'ections for the application of this apparatus, see p. 311*
of this No.
Harris's Cases of Neuralgia, 385
In this case there had been used leeches and blisters to the back
of the neck, chaljbeates, narcotics, and most of the other agents
usually recommended in this disease.
I suggested to Dr. Otto the use of the galvanic apparatus, to which
he readily assented. It was accordingly applied in the manner al-
ready detailed. On the eleventh day of its application the pain en-
tirely ceased, and although two years have elapsed, he has had no
return of it.
After fatiguing study he has several times had a return of his las-
situde and gloomy spirits. He is now, however, in fine spirits and
robust health.
In January, 1833, I was consulted by Mrs. R. aged forty-eight, in
relation to a neuralgic affection of her head and face of eight years
continuance. She had been under the care of one of our most emi-
nent physicians, who had assiduously applied the usual remedies
without effect. She had intervals of ease on two occasions during the
warm months.
On the fourth day after the application of the galvanic apparatus
the pain began to diminish, and on the twenty-third day it ceased en-
tirely.
In the month of April following she had a slight return of it, occa-
sioned by exposure during a cold, inclement day. This attack yield-
ed to a reapplication of the apparatus for ten days. She has had an-
other slight return of the disease this spring, but which has been
again subdued by galvanism.
In May, 1833, I was applied to by Miss E. D. of this city in case
of neuralgia of fourteen years standing. This case in point of acute-
Bess of suffering, was of a most aggravated character. It was dif-
fused over every part of the body. The head, face, tongue, heart,
stomach, uterus, and indeed almost every region of system, was by
turns invaded by this terrible disease. The galvanic apparatus was
applied in this case, and faithfully continued for five weeks. The
effect was to mitigate the violence of the disease, but not to cure it.
In the same month I applied the galvanic apparatus to S. T. aged
thirty years, a female patient in the Pennsylvania Hospital. She
was affected with general neuralgia of six months standing. The gal*
vanic apparatus was applied in this case, and continued for weeks
without producing any perceptible benefit.
In November, 1833, Mrs. of New York, desired my advice
in a case of neuralgia of fourteen years standing. Like the two pre*
ceding cases every part of the body was by turns severely affected by
this disease. The failure of this agent in the similar cases gave me
No. XXYIII.— August, 1834, 33
386 Harris's Cases of Neuralgia.
little encouragement to hope for success in this. At the request of
the suffering lady, however, the apparatus was applied and continued
with the exception of short intervals for five months. The lady has
returned to New York with the impression that she has been in some
degree relieved, but is far from being cured.
In February, 1834, the galvanic plates were applied in the case of
Miss P. of Philadelphia, who had been affected with neuralgia of the
face for two years. After the tenth day the pain entirely ceased,
and she continues quite relieved.
In May, 1834, Mr. T. W. of Maryland, consulted me in a case
of neuralgia of the head and face of eighteen months continuance.
He had been under medical treatment during the whole of this period,
but could not state the names or nature of the medicines which he had
taken. His pain was very acutej his nights were sleepless; his diges-
tive functions much impaired, with obstinately constipated bowels.
His extremities were cold, and his head inordinately hot. A few
ounces of blood was taken from the back of his neck, aperients were
given to regulate his bowels, and his feet were placed nightly in a
mustard foot-bath. On the third day the galvanic apparatus was ap-
plied, and was continued two weeks before any mitigation of the pain
was observed. At the expiration of five weeks the patient was entire-
ly relieved of his neuralgia, and his health in every particular entirely
restored. Within a few days he has returned to his native state in
fine health and spirits.
Of the eight cases which have been treated with the galvanic agent
five have been entirely relieved. In every case in which the disease
was located in the cerebral nerves, this simple and apparently feeble
galvanic apparatus has accomplished cures. On the contrary, where
this disease was diffused throughout the body, or located in the
spinal nerves, it has failed.
At some future period, and after further experience, I propose com-
municating to you my views in regard to the modus operandi of gal-
vanism in the cure of neuralgic affections.
Very truly,
THOMAS HARRIS.
Dr. Isaac Hays.
Philadelphia^ June SOth, 1834.
SvifQiih Instance of Destruction of the Uterus, Sec. 387
Art. XL Instance of Destruction of the Uterus^ Perineum and Rec-
tum, after Delivery, with Recovery. By Dr. John Swett, of
Ridgwaj, New York.
A WOMAN, aged thirty years, of robust constitution, was deliver-
ed of her first child on the 28th day of June, 1830, full-grown, after
thirty-six hours severe labour. During this preternatural labour blood
was abstracted, and three or four doses of opium administered; for-
ceps of a bad construction were unsuccessfully applied by a physi-
cian little acquainted with the use of instruments; the parturient
pains immediately ceased, palsy and weakness of the lower extremi-
ties ensued, with pain in the back and hips. The patient was left in
this situation, by her attending accoucheurs, several hours, whilst
they reposed on their beds! The child was born with little manual
assistance, and without an effort of the parent.
On the 2d day of July I was called and visited this unfortunate
female, and found her labouring under very acute pain; pulse one
hundred to the minute, vomiting a green and dark-coloured bile. Her
friends had despaired of her life.
In this case I administered the sulphate of magnesia in a cathartic
dose, which immediately prevented the vomiting, and in a few minutes
she requested food, which being allowed her, was found agreeable to
iho, stomach; and as often as the vomiting took place, the same me-
dicine was administered with the same effect as above stated.
On inspection I found the labia pudendi and posterior region in a
gangrenoufe state; for this I prescribed yeast and charcoal, internally
and externally, and also the cort. peruv. flav. acidulated with the sul-
phuric acid, together with wine to support the system.
The 12th day of the same month I found her labouring under tym-
panitis; I therefore discontinued the former medicines, and adminis-
tered the ol. ricini freely; directed ablutions of cold water, and a
bandage to be applied to the abdomen; in a few hours the bowels
were evacuated, a gentle diaphoresis appeared, and she was again re-
lieved from pain.
On the ISth it was found that the fundus uteri had passed into the
vagina, and out at the os externum: by a little assistance of the nurse
the whole uterine system separated, leaving its destined place of abode.
\5th. The rectum parted a few inches above the pubes, and was
discovered sliding down and passing out between the labia puden-
dorum; the nurse in my presence took hold of and gently extracted
it, the lower end easily separating from the sphincter ani, and with-
388 Swett's Instance of Destruction of the Uterus, <5'C.
out pain to the woman. At this time I proceeded to a further ex-
amination, and found the perineum destroyed, so much so as to leave
but one orifice to the abdomen, (and that) extending from the os
coccjgis to the ossa pubis. The sphincter urinae also had lost its
power of contraction, and she labours under an incontinence of urine
and faeces. She sutFered several weeks with cruritis or phlegmasia
dolens, partially submitting to the antiphlogistic plan of treatment.
In the month of November following, by an inspection I found the
pelvis to be healed, and could of a certainty discover the purulent
discharge flowing from the abdomen. A portion of the intestine had
visibly descended into the pelvis three or four inches, folded down,
and hung pendulous over the sacrum in the vaginal cavity, and which
was sensibly affected with cold air; for this a pessary of fine sponge
was applied, and at length found useful in retaining the intestine in
the abdomen, and in effectually excluding the cold air. So great was
the destruction of parts, and so extensive the orifice, that the eye
could trace the whole internal cavity of the pelvis so distinctly in this
case that I had ocular demonstration both externally and internally,
that the rectum as well as the whole uterine system had separated
and were removed. Another fact of which I was informed, and had
no reason to doubt, and which should by no means 'be omitted, is,
that the faeces had ever from the time of the above occurrence passed
oft* between the labia.
Notwithstanding all the suff*erings of this patient in the entire loss
of (these) important viscera, the great length of time she was sick con-
fined to her bed, and the continued inflammation of the abdominal vis-
cera keeping up a purulent discharge, yet her strength, by the assist-
ance of a remarkable appetite, held out, and health was fast returning.
About the 1st of January, 1831, the mammae began to perform the
office of secretion, so that milk flowed in profusion, and continued
so about two months and then ceased. This phenomenon happened
six months after the extraction of the foetus, apparently producing no
material change in the other functions of the system either by its con-
tinuance or cessation. Health now returned with bloom and vigour.
February I6th, 1832. — I am informed by the father of this woman
that she can now in some small degree command the urinary organs,
and feels a sure confidence that in one year more she shall possess
the full command: this is in my opinion possible, but over the fa3ces
she can never have controul. The inconveniences which she must
ever for life sustain from incontinence of urine and faeces, are very
great: yet her health in every other respect is unexceptionably good
to this day, viz, March ^4t\\^ 1833.
( 389 )
REVIEWS.
Art. XIT. Emhryologie ou Ovologie Humaine, contenant VHistoire
Descriptive et Iconographique de V (Euf Humain. Par Alf. A. L.
Velpeau, Chirurgien de PHopital de la Pitie, Agrege a la Fa-
eulte de Medecine de Paris, Professeur d'Anatomie, d'Accouche-
mens et de Medecine Operatoire, Chevalier de la Legion d'Hon-
neur, Membre de PAcademie Royale de Medecine, de la Societe
Medicale d'Emulation de Paris, Correspondant des Societes Me-
dicates de Tours, Louvain, Rio Janeiro, &c. &c. Accompagnee
de quinze planches, dessinees et lithographiees, par A. Charal.
Paris, 1833. Fol. pp. 104.
Embryology^ or Human Ovology, containing the Description and
Iconographic History of the Human Ovum. By Alf. A. IT. Vel-
peau, &c. &c.
Graphic Illustrations of Abortion and the Diseases of Menstruation.
Consisting of twelve plates frow drawings engraved on stone, and
coloured by Mr. J. Perry, and two copperplates from the Philoso-
phical Transactions, coloured by the same Artist: the whole repre-
senting forty-five specimens of Aborted Ova and Adventitious Pro-
ductions of the Uterus, with preliminary Observations, Explana-
tions of the Figures, and remarks, Anatomical and Physiological.
By A. B. Granville, M. D., F. R. S. &c. London, 1834. 4to.
pp. 52.
jyi. VELPEAU is one of the most prolific, and at the same time,
most distinguished writers of the day. Within the last four years he
has published three large works, besides others of a minor descrip-
tion :-^an Elementary Treatise on the Art of Midwifery, in two vo-
lumes, 8vo. — New Elements of Operative Medicine, (with an atlas
of twenty plates, in 4to.) in three large volumes, octavo; — and a
Treatise on the General, Surgical, and Topographical Anatomy of
the Human Body, in two volumes, 8vo., with an atlas of fourteen
plates, in 4to. ; — all of which have been translated in this country:
besides a Memoir on the Faulty Positions of the Foetus, in 8vo. — a
Dissertation on the Generalities of Surgery, and on the Plan to be
Pursued in Teaching the Science, in 4to. — Researches on the Spon-
taneous Cessation of Primary Traumatic Haemorrhages, and on the
Means which may, in certain Gases, be substituted for the Ligatur®
33*
390 Velpeau's Embryology , or Human Ovology, S^^c,
of Arteries, in octavo; and a Dissertation on the Generalities of Phy-
siology, in quarto; besides the large work now before us, and to
which we are desirous of attracting the attention of the professi9n.
But, although prolific, it must not be presumed, that the produc-
tions of M. Velpeau bear signs of hasty concoction. His mind is ma-
nifestly of no common order. It is grasping, and retentive; and the
materials which he treasures up, are so arranged as to be easily ad-
duced. His productions, too, are chiefly on topics on which he has
been accustomed to deliver lectures, so that M^e can, in some mea-
sure, account for the rapid succession of publications — all full of im-
portant facts and speculations — and in every way creditable to the
author.
That the work before us is no hasty production, and has undergone
the *' limae labor ac mora," is sufficiently shown by the fact, that the
ideas on which it is founded, were communicated to the Academu
de Medecine of Paris, in 1824, to the Societe PMlomathique^ in 1826,
1827, 1828, and 1829; and the work was subjected, almost in its en-
tire state, to the Academie des Sciences, in 1827 and 1828. He as-
serts, too, in his introduction, that it is the fruit of researches into
which he entered so long since as 1821.
As our object is to give a concise account of the more prominent
topics insisted on by M. Velpeau, and to inquire into some of the
obscure, but deeply interesting questions of foetal existence, we
shall pass by, without further notice, the controversial preface, which
occupies twenty-eight folio pages, and is dedicated to " a critical re-
view of the opinions emitted before and since his first publications on
the principal points canvassed in the work."
The first section is on the appendages (annexes) of the foetus, —
the membranes, vesicles, placenta, and umbilical cord.
The membranes consist of the chorion and amnion; and although
furnished by the uterus, yet being a contingent on the state of gesta-
tion, the decidua may be added. This last membrane has long been
a subject of controversy, and still continues to be so; — various opi-
nions having been entertained regarding the formation of the decidua
reflexa especially; each of which has, even now, numerous adher-
ents.
Dr. William .Hunter, to whom M. Velpeau awards the discovery
of the decidua, conceived it to be thicker the nearer to the time of
conception, and that it became gradually thinner during pregnancy;
still existing, however, during delivery, and being then thrown oft'—
whence its name decidua — and renewed at each pregnancy. He con-
sidered it to have three apertures; one corresponding to the os uteri,
Velpeau's Embryology^ or Human Ovology, Spc. 391
and one to each Fallopian tube: that at first it consisted of one layer,
adherent to the uterus; but subsequently a second was formed, which
adhered to the ovum, and which he called tunica decidua reflexa.
The opinions of most of the anatomists of the present day, are in
favour of one of two views. It is maintained by some, that one of the
first effects of conception, is to cause the secretion of a considerable
quantity of a sero-albuminous substance from the inner surface of the
uterus; so that the organ becomes filled with it. On the first arrival
of the ovum in the uterus, it falls into the midst of this secretion,
gradually absorbing a part by its outer substance for its nutrition.
The Remainder is organized into a double membrane, — one corres-
ponding to the uterus, the other adhering to the ovum. This sero-al-
buminous substance is conceived to plug up both the orifices of the
Fallopian tubes, and that of the uterus.
By others, it is held that the decidua is slightly organized, prior
even to the arrival of the ovum, lining the whole of the cavity, and
being devoid of apertures: so that, when the ovum passes along the
tube, and attains the cornu of the uterus, it pushes the decidua be-
fore it| the part so pushed forwards constituting the tunica decidua
reflexa, and enveloping the whole of the ovum, except at the part
where the decidua leaves the uterus to be reflected over it. This is
the seat of the future placenta. Such is the opinion of our author.
" Impreg-nation," he remarks, " occasions a specific excitation in the uterus^
promptly followed by an exhalation of coag-alable matter. This concretes, and
is soon transformed into a kind of cyst or ampulla, filled with a transparent or
slightly rose-coloured liquid. This species of bladder is in contact with the
whole surface of the uterine cavity, and extends sometimes into the commence-
ment of the tubes, and most frequently into the upper part of the cervix, in the
form of solid, concrete cords; but it is never perforated naturally, as HunteF
thought, and as Bojanus, Lee, and some other authors still think.
" When the ovule has passed along" the tube, it depresses this membranca
glides between it, and the uterus, to the inner surface of which it ultimately
glues itself. After this, the decidua is formed of two continuous portions, one
very extensive, lining the whole of the womb, except the part which is in con-
tact with the germ, and bearing the name— w^erme, //we, or external decidua;-—
the other, smaller, and pressed upon by the free half of the fecundated vesiclca
which it envelopes, constituting the decidua reflexa^ or interna. It is this, which
Messrs. Owen and Lee call ovuline, but which ought rather to be called epicJio-
rion. The extent of the former increases in the same proportion as the uterus»
The augmentation of the second necessarily follows that of the germ. Hence
the cavity which separates them, and which is nothing more than the misshapen
cavity of the primitive ampulla, is greater the less the time after the first pe-
riods of gestation.
" The decidua uteri retains a pretty considerable thickness, especially around
the placenta, until the end of gestation. The epichorion, on the contraryj ge-
:l_^
392 Velpeau's Embryology, or Human Ovology, SfC,
nerally becomes insensibly thinner, and thinner, so that, at the full period, it is
sometimes of extreme tenuity.
" Towards the third or fourth month, — a little sooner or later, — they touch
and press upon each other; and remain in a more or less perfect state of conti-
guity, until the expulsion of the secundines, but they are never confounded, al-
though Hunter, and the majority of those who have treated the same subject
since his time, have asserted the contrary. If Mr. Lee has not been able to se-
parate them after the fourth month, it has been owing to his not having taken
into account the reflected layer, which rests strongly glued upon the chorion,
when we begin to detach the decidua uteri from it, and to his having evidently
confounded, in the outset, this last with the internal membrane of the uterus."
p. 3.
Between the decidua and false membranes, which are the result of
inflammation, M. Velpeau thinks there is no analogy. He regards it
as a "simple concretion" — a layer without regular texture, whether
we regard the decidua vera or the reflexa; and he argues, that if it
were really organized, if it were the seat of exhalation, it ought to
contract some adhesion, and be intimately confounded with the inner
surface of the uterus, or the circumference of the chorion, which it
lines, and covers for nine months.
" Is it from the placenta that it receives its vitality? It is developed for a long
time before the placenta begins to be formed. This body can generally be de-
tached from it, as well as the whole of the ovule, up to the second month of
gestation, without any thing being destroyed or torn, which could give the
least idea of a determinate organization. It is, moreover, sufficient to recollect,
that the structure of this singular membrane is precisely the same at the mo-
ment of parturition, as at the beginning of pregnancy-r—a period at which most
authors agree that it has no true texture." p. 7.
Being consequently, in his opinion, the *' product of an excretion"
from the uterine cavity, M. Velpeau gives it the name — " anhistous
membrane, (from csv, privative, and Jo-ra?, a web,) or "membrane
without texture." There has, indeed, been a striking dissatisfaction
with the name decidua. Dutrochet has proposed to call it epione,
Breschet, perione, and Burdach, nidamentum.
Its use, the author thinks, is to retain the fecundated ovum to a
given point of the uterine cavity; and if M. Velpeau's views of its
arrangement be accurate, the suggestion is good. In favour of this
arrangement a good deal may be said. If there were apertures in the
decidua, corresponding to the Fallopian tubes, it would seem that
the ovum ought frequently to fall from one of them into the sero-al-
buminous matter at the cervix uteri, an attachment of the placenta
over the os uteri would be likely to occur more frequently than it is
known to do. Under M. Velpeau's doctrine^ the attachment of the
Velpeau's Embryology, or Human Ovology, S^c. 393
placenta ought rather to be near the cornu of the uterus, which is
known to be the case.
It is not so easj to subscribe to the author's views regarding the
" inorganic" nature of the decidua. Many excellent observers have
asserted, not only that this membrane exists between the placenta
and the uterus, which M. Velpeau's view, of course, renders impos-
sible, but that numerous vessels pass between it, the uterus, and the
placenta. We know, too, that the safest and most effectual mode of
bringing on premature labour, is by detaching the decidua from the
cervix uteri, or, in other words, by breaking up the vessels that form
the medium of communication between it and the lining membrane
of the uterus. How could this have any effect unless such vessels
existed? It may be said, indeed, that the mere separation of the un-
organic pellicle, as M. Velpeau designates it, may be a source of ir-
ritation, and excite the uterus to the expulsion of its contents; and
we do not deny that this is possible. Yet M. Velpeau affirms — " no
tissue attaches it to the uterus. It adheres to the inner surface of the
organ merely in the manner of an excreted, membraniform shell,
(plaque, "j
As regard the chorion — the outermost of the foetal membranes-
much difference of opinion has existed; some supposing it to consist
of several layers — others, as M. Velpeau, of one only. The conclu-
sions to which his observations lead him, are as follows: —
"First. The chorion — in the human species — is a simple round vesicle."
" Secondly. Its villosities are not vessels, but merely small, granulated fila-
ments, v/hich serve at a later period for the development of the vessels of the
placenta, on the portion of the ovule that touches the inner surface of the ute-
rus or corresponds to the root of the cord."
These villosities, we think it probable, act as true sponges, to ab=
sorb the necessary nutriment for the maintenance of the life of the
embryo.
*' Thirdly. To the granulations of its filaments ought to be referred the ori-
gin of the hydatids en grappe, sometimes met with in the womb, or forming
part of an hydatid mole."
M. Velpeau does not regard these hydatids as vesicular worms,
but as arising from an *' abnormal development of the granulations,
or rather as the product of an aborted ovum, whose small, gangliform
bodies have assumed an increase not common to them; and he affirms,
that he has a number of preparations in proof of his views.
It has always appeared to us extremely questionable, whether
these false conceptions, as they have been considered, are really ace-
394 Velpeau's Embryology, or Human Ovology, S^c,
phalocystsj and this doubt we have been in the habit of expressing
for many years in public; but still the precise mode in which such
morbid formations arise is not easy of decision. It may take place in
the way mentioned by our author, but we wait, prior to deciding, for
the ''particular memoire," which he proposes to issue on the sub-
ject.
'^Fourthly. In the normal or regular state, half, at least, of these gangliform
bodies implant themselves in the epichorion, and cease to be developed; whilst
the others, in contact w\\h the uterus, or corresponding' to the vessels of the
cord, constitute the rudiments of the placenta."
This view of the general anatomy and purposes of the granulations
is peculiar to M. Velpeau. We shall refer to it presently, when we
consider the anatomy of the placenta.
" Fiftlily. The chorion is not an expansion of the skin, or of any part of the
abdominal parietes, as many authors have asserted, and as I, at one time sup-
posed; but it has, from the commencement of gestation, relations, and an inti-
mate continuity with the cellular web of the cord, or of the umbilical vessels."
The opinion, that the chorion is an expansion of the skin, is as old
as Hippocrates, and is generally entertained. M. Velpeau himself,
as he honestly admits, published some cases in 1824 in support of
the view; and it has been maintained, amongst others, by Mondini,
MojoN, Roux, Chevreul, and De Blainville. The reasons, how-
ever, advanced by M. Velpeau, for the opinion he now entertains,
are cogent.
** The chorion forms part of the ovule from the commencement of gestation.
The parietes of the abdomen are not developed until after the spine. Before
the appearance of the skin the chorion presents the same characters, and the
same form as it possesses afterwards. The chorion then, and the skin of the
embryo are two parts independent of each other.
** In the first month of its development, the chorion ought to be studied, in
order to form an exact idea of its connexion with the other parts of the ovule.
The umbilical cord, then very small, appears to be only a small cellular stalk,
which terminates in the chorion at one extremity, and in the concavity of the
rachidian circle at the other. The amnion attached to this stalk at one point
only, which is very close to the embryo, appears to be pierced by it. If we
did not admit that the chorion is independent of every other part of the foetus,
it might be considered as the expansion of the cellular web of the umbilical and
placental vessels; but as these canals do not appear until some considerable
time after fecundation, it is evident that the chorion must serve them as a ma-
trix or canvass, and cannot be produced by them. At a subsequent period, it
is so intimately confounded in the cord with the amnion, and especially with
the ring of the umbilicus, that it becomes impossible to deny with certainty its
continuity with the integuments." p. 19.
" Sigcthly, It is not multifoliated at any period of its development."
Velpeau's Embryology^ or Human Ovology, fyc. 395
The idea has generally been, amongst descriptive anatomists, that
the chorion consists of several layers. The author, however, accords
with Hunter, that there is but one. Many embryologists still main-
tain the opinion of HalLer, Ruysch, Hewson, and others. Amongst
these may be named Chevreul, Maygrier, and Dutrochet. " In
the human ovum," says the last distinguished observer, " there is an
exochorion, that is, an outer chorion, formed of several layers, and
an endochorion or inner chorion, resulting also from the adossemeni
of several primitive layers." There is, however, as M. Velpeau has
correctly observed, after Dutrochet, great obscurity thrown over this
minute and intricate point of fcetal anatomy, owing to the same name
having been employed for foetal envelopes very different from each
other, whilst different names have been given to the same membrane.
M. Velpeau asserts, that at fifteen days, and three weeks, as at
two months, the chorion is simple in the human species, and —
** If, at a later period, other layers are united with it, they belong* to bodies
not yet described, or which cannot, under any pretext, be considered as its de-
pendencies."
" Seventhly. It does not receive either vessels or nerves, which belong pro-
perly to it."
On this point great dissidence likewise prevails; and although it
might seem that anatomy should be one of the "exact sciences,"
there is hardly any which is more unfixed, if we regard the different
tissues, which are so minute as to require the aid of the microscope.
In such cases, wide scope is left for the imagination, and the reck-
less theorist can devise any arrangement, which will best serve his
purpose. Hence it is, that we have the presence of blood-vessels,
nerves, and absorbents admitted '"^from observation" by some, and
as strenuously denied by other ''transcendental anatomists," as they
have been lately called in the land of imagination and metaphysical
physics. Before we can learn the physiology of organs, it is of course
necessary that such organs should be proved to exist; yet the onus
probandi is far more difficult than the gratuitous belief, that such an
organization may be, and is present, and accordingly it is eagerly
embraced, provided the assumption will throw any light on the hypo-
thesis of the speculatist. The crying evil with the anatomist, and
still more with the credulous physiologist, is, that he knows too
much, and too readily takes for facts the assertions and speculations
of his distinguished brethren; and nothing but a rational scepticism
will correct the evil, and bring him back to the lessons of true obser-
vation. It would be an ungracious task, but science could not fail
to reap important advantages from it, were some competent indivi-
396 Velpeau's Embryology^ or Human Ovology, Sf-c.
dual to sift the known from the unknown, and the doubtful, and to
classify them accordingly. Fresh experiments might then be insti-
tuted, which would substitute certainty in the place of doubt, and
dispel that immense mass of false knowledge which yet exists, but
which is every day yielding before the lights of more accurate obser-
vation and reflection.
The texture of the chorion, as well as of the amnion, M. Velpeau
admits to be cellular, and if we call into our aid what analogy has
suggested, we should be compelled to infer the existence of both
nerves and blood-vessels, and that the membrane, like other varieties
of cellular membrane — the serous, for example, is possessed of simi-
lar functions^ and such is probably the case, even if we admit, with
M. Velpeau, that no nerves or blood-vessels can be traced in it. We
have strong evidence that both nerves and blood-vessels are present
in parts where the anatomical analyst has not yet succeeded in de-
tecting them in healthy yet these parts are very sensible, and exhibit
vascularity when inflamed. It is known, too, that many anatomists
have taken the affirmative side of this particular question. Chaussier
and RiBEs, for example, and Sir Everard Home and Bauer assert,
that they have detected nerves^ whilst a host of inquirers have de-
posed to the presence of blood-vessels. Wrisberg and Sandifort
are the chief authorities, however, on that side; whilst Mayer, our
old preceptor, Beclard, Lobstein, and M. Velpeau, have never
succeeded in finding them.
*' In refusing to admit blood-vessels in the shaggy coat of the human ovum,"
says M. Velpeau, "I rest on the following points. First. No one has seen them
so as to leave no doubt on the subject. Secondly. The ineffectual efforts made
by M. Lobstein to discover them. Thirdly. My own observations: and Fourthly.
I think I have found the reason which has deceived many observers who have
admitted them.
" When we endeavour to separate the decidua rejlexa from the outer surface
of the chorion, we soon perceive an indefinite number of filaments passing from
one to the other. These filaments, which are more numerous as we approach
the placental surface, and the nearer to conception, and which Sandifort and
many others have taken for vessels, are mere vestiges of the villous tomentum,
which covered the outer surface of the ovule. Now, if a number of physiolo-
gists accord a sanguineous circulation and vessels to the chorion, it is because
they believe their existence on the decidua demonstrated, and hence they have
considered that such must be the case in the membrane immediately beneath
it. But this argument falls to the ground, if we prove, as I think I have done,
that the former of these lamina is a mere anorganic concretion." * * *
*' The finest injections, the most careful dissections, both of the chorion itself,
and of its filaments at an advanced period; and of its shaggy state, and its gra-
nulations at an early period, have not left in my mind the slightest doubt. With
Velpeau's Embryology^ or Human Ovology, 8fC. 397
the magnifying' glass, or with the scalpel, these objects appeared solid, and
tore like cellular tissue. I never was able to remark the slightest appearance
of a canal." p. 21.
He remarks, however, in a previous paragraph, that he wishes it
to be particularly understood, that his assertions apply only to the
human female. " In the mare, the outer surface of the chorion is
red and vascular, from the base to the summit of the ovum^" — a
strong analogical fact, by the way, which ought to make us pause
before we are satisfied that our limited powers of observation have
proved the negative as regards our own species.
** Eighthly. It is of a cellular nature, and is formed by the same mechanism as
the serous membranes."
We have already referred to objections which this conclusion sug-
gests to the one preceding. To it, abstractly considered, no objec-
tion can be made.
** Ninthly. In all animals in which a decidua, or some analogous layer, exists,
the chorion forms the second membrane of the ovum — proceeding from without
to within, and the first, when there is no anhistous concretion, (decidua.")
** Tenthly. At the full period, its outer surface, covered by the epichorion
and placenta, is reflected over the root of the cord, which it invests as far as
the abdomen of the foetus. Its inner surface is every where in contact with the
amnion." p. 23.
The amnion^ although more frequently spoken of than the chorion,
has been, perhaps, less accurately examined; and hence, according
to M. Velpeau, almost all writers copy from each other in describing
it. What has been said of the chorion, regarding the supply of
nerves and blood-vessels, applies also to the amnion. Our author
denies their existence in toto| yet, what is singular, he regards the
liquor amnii as —
** The product of transudation, or of simple exhalation, like the serosity of
the pleura, pericardium, peritoneum, or arachnoid; like the synovial humour of
the tendinous shealhs, or of the articulations, and this perspiration has no need
whatever of particular canals to effect it; it is a purely vital imbibition, and the
filamentous matters that trouble it, the yellow or green floccuh sometimes
found in it, belong in no way to it, and are nothing but portions of meconium,
or of the enduit separated from the foetus, or else of the vitriform substance,
and of the vesicles, that exist primitively between the membranes."*
Yet all these exhalations require, in our view, the action of vessels
to eifect them. They must be derived /rom the blood, and therefore
they must escape from the vessels in which it is contained. What
• Traitd ^lementaire de I'Art des Accouchemens. Tom. I, p. 253.
No. XXVIIL— August, 1834. 34
398 Velpeau's Embryology^ or Human Ovology, 8fC.
we have already observed regarding the non-detection of vessels con-
taining blood — red or white — in the chorion, applies equally to the
amnion; and the very fact of a fluid existing in its interior, which is
admitted by M. Velpeau to be exhaled from it, is an additional ar-
gument in favour of the presence of vessels.
The author's conclusions with regard to the amnion, in the work
before us, are as follows: —
" 1. The amnion or agnelette is the innermost, and deepest-seated membrane
of the human ovum.
«* 2. In every case in which the g-erm is not abnormal, it is separated from the
chorion by a space, which is at first very considerable, but which afterwards
diminishes insensibly, from the first fortnight to the third or fourth month of
pregnancy."
" 3. Its outer surface, although less smooth than the other, has neither cel-
lular filaments nor vessels which can unite it to the chorion."
'* 4. Its inner surface is primatively very near the embryo, from which it is
afterwards removed in proportion to the development of the ovum."
" 5. It is not enth'ely correct to maintain, with Hippocrates, Harvey, and
Burton, (as I believe I have demonstrated myself,) and as Dr. Pockels has again
asserted, that the amnion is originally continuous with the epidermis, of which it
would be only a dependence, or which, in this way, would be produced by it."
*' 6. In the first month it has no connexions except with the umbilical cord,
which seems to perforate it in proceeding towards the spine to be lost in some
of the abdominal viscera."
*' 7. At a later period, when the parietes of the abdomen are formed, it
unites somewhat intimately with the epidermic layer of the embryo, or of the
foetus, so that it is difficult not to admit a real continuity between the two
layers."
" 8. It contains no vessels that are proper to it, and there never enters more
than a single layer into its composition."
" 9. The connexions of the amnion with the embryo, in the other mammalia,
are the same as isi the human species." p. 32.
The second chapter of the work is appropriated to the vesicles that
are described as belonging to the human ovum; to wit, the umbilical,
allantoid, and erythroid.
The umbilical vesicle was unknown to the ancients; and amongst
the moderns it is not universally admitted to be a physiological con-
dition; but, on the contrary, is regarded as a morbid formation by
many, and we are somewhat surprised to find M. Velpeau remark,
that out of about two hundred vesicles, which he had examined in
foetuses under three months of development, he had met with only
thirty in which the umbilical vesicle was in a state that could be
called natural, p. 39.
With such facts before him it is not easy to understand how the
Velpeau's Embryology^ or Human Ovology, S^c. 399
author could distinguish the physiological from the pathological con-
dition. If the existence of the vesicle be a part of the physiological
or natural process, the majority of cases ought to be healthy or natural;
yet he pronounces the thirty in the two hundred to be alone properly
formed, and of course one hundred and seventy to be morbid or un-
natural!
The umbilical vesicle, according to M. Velpeau, is a small, pyri-
form, round, or spheroidal sac; which, about the fifteenth or twentieth
day after fecundation is of the size of a common pea. It probably
acquires its greatest dimensions in the course of the third or fourth
week. After a month he has always found it smaller. When it
becomes reduced to the size of a grain of coriander, which generally
happens about the fifth, sixth, or seventh week, it commonly ceases
to diminish. After this, it becomes flattened, and disappears insen-
sibly. At times, it is not found after the third month; whilst at others
it is seen as late as six months. It is incontestably situated between
the chorion and the amnion. Commonly, it is adherent either to the
external surface of the amnion, or to the inner surface of the chorion;
but at times it is situated loosely between them.
The characters of the pedicle^ which M. Velpeau terms pedicule
vitellirif and which attaches the vesicle to the embryo, vary according
to the stage of gestation. At the end of the first month, it is not less
than two, nor more than six lines long, and about a quarter of aline
thick. Where it joins the vesicle it experiences an infundibuliform
expansion; not so at the extremity which joins the abdomen.
Its continuity with the intestinal canal in man cannot, he con-
ceives, be doubted. Before the parietes of the abdomen are com-
pletely formed, it is divided, as it were, into two portions by the
amnion, which it seems to have pierced. Up to twenty or thirty days
the pedicle is hollow. In two subjects, M. Velpeau was able to press
the liquid from the vesicle into the abdomen without lacerating any
part. It becomes obliterated at a somewhat uncertain period. Gene-
rally, the canal does not exist longer than the expiration of the fifth
week; and the obliteration appears to proceed from the umbilicus to-
wards the vesicle, in proportion as the cord becomes complete, and
it probably closes first at the ring of the umbilicus.
The parietes of the vitelline poach, — as M. Velpeau also calls it, —
from its analogy with the vitelline or yolk-bag of the chick, — are strong,
resisting, somewhat thick, and diflicult to tear.
As the umbilical vessel of brutes has been admitted to be conti-
nuous with the intestinal canal, anatomists have assigned to it and its
pedicle three coats. Such is the view of M. Dutrochet. M. Velpeau
400 Velpeau's Embryology, or Human Ovology, <^c.
has not been able to detect these in the human foetus. He admits,
however, "a serous surface, and a mucous surface, but not a serous
membrane, and a mucous membrane, still less a muscular coat.^^
The vesicle is evidently supplied with arteries and veins.
" I have observed them," says M. Velpeau, " not only in the substance of the
parietes of the vitello-intestinal canal, but also in those of the vesicle itself;
twice in the latter, more than twenty times in the umbilical cord. In the first
case, I have seen them form a beautiful net-work, and numerous arborescent ra-
mifications, extremely easily traced without any particular preparation, and
even with the naked eye. In the second case, they were reduced to two very
fine trunks at the side of the vesicle, becoming" gradually larg-er as they ap-
proached the abdomen. These vessels, of which Boehmer and Madei appear
to have had some notion, which are somewhat coarsely represented in the
work of Hunter, which Wrisberg and Blumenbach have described better,
which Kieser, Ribes, and Chaussier have made known in France, and which
many zoologists have regarded, and still regard, as the only means of commu-
nication existing between the embryo, and the umbilical vessel, are known in
science under the name omphalomesenteric vessels, but rather merit, in my opi-
nion, the title vitello-mesenteric, or simply vitelline. From my observation, they
do not proceed, as has been said, to empty themselves into the superior me-
senteric vein and artery. I have remarked, that they communicate with one of
the branches of the second or third order of these great canals, with those, in
particular, that are distributed to the coecum. I have often traced them from
the abdominal cavity through the ring of the umbilicus, as far as one, two, and
even three inches into the cord, in foetuses six weeks, two, and three months
old. At these different periods, however, they ultimately disappeared, and
were lost in the spongy tissue of the vitelline pedicle before attaining the vesicle,
which must be attributed, doubtless, to the same causes that produced the ob-
literation of the vitello-intestinal canal. I have several times succeeded in in-
jecting them, when they had the size of a large hair; but their delicacy is gene-
rally so great, that they readily give way, unless the greatest precautions be
taken." p. 44.
These vessels are regarded as the vessels of nutrition of the um-
bilical vesicle.
The fluid, contained in it, which M. Velpeau calls the vitelline
liquid, is supposed to possess similar uses with the vitellus or yolk in
birds. In a favourable case for examination, M. Velpeau found it of
a pale yellow colour; opaque; of the consistence of a thickish emul-
sion; different in every respect from serosity, to which Albinus,
BoERHAAVE, Wrisberg, and LoBSTEiN have compared it, and from
every other fluid of the organism; and he regards it as a nutritive sub-
stance, a sort of oil, in a great measure resembling that which con-
stitutes the vitelline fluid of the chick in ovo. Under this point of
view its uses would appear to be obvious; — to afford a nutritive fluid
for the development of the embryo, until the cord and the vessels
Velpeau's Embryology, or Human Ovology, Sfc. 401
are formed, and until the ovule is accurately connected with the inner
surface of the uterus.
** From the moment of fecundation until the ovule is attached to the uterus,
the product of human conception is almost entirely like the eg-g- of birds. Free,
and independent, like it, of every part of the mother, it must convey with it
materials for its support, in the same manner as the chick, inclosed in its shell,
requires some substance to serve for its evolution. In the one case, it is true,
this arrangement is only temporary, whilst in the other it continues during the
whole period of incubation; this difference being owing to the circumstance,
that, in the former, incubation takes place in the interior of living organs, organs
which can furnish abundant nourishment to the young plant; whilst, in the se-
cond, every thing occurs in the atmosphere, exterior to the parts of the adult
animal." p. 45.
The allantoid vesicle or allantois has been alternately admitted, and
denied to be a part of the appendages of the human foetus, from the earli-
est periods until the present day. It is situated between the chorion
and amnion, and communicates with the urinary bladder by a canal,
called the nrachus. It has been observed in the dog, sheep, cow,
the saurian and ophidian reptiles, birds, &c. It is formed at a very
early period; rapidly acquires a considerable capacity; and contains
a matter, which is not the same at all periods of gestation, or in all
animals.
The description of M. Velpeau by no means satisfies us, that sucii
a vesicle exists in the human subject. He was never able to detect
any communication with the urinary bladder, and he is compelled to
have recourse to analogy to admit that any such channel has, in
reality, existed.
From all his facts, which are sufficiently meagre —
** He thinks himself authorized to say, that from the fifth week after concep-
tion, till the end of pregnancy, the chorion and the amnion are separated by a
transparent, colourless, or slightly greenish-yellow layer. This layer, instead
of being a simple serosity, is lamellated after the manner of the vitreous humour
of the eye. It diminishes in thickness in a ratio with the development of the
other membranes. The quantity of fluid, which its meshes inclose, is, on the
contrary, in an inverse ratio with the progress of gestation. Becoming gra-
dually thinner, it is ultimately formed into a homogeneous and pulpy layer, by
transforming itself into a simple, gelatinous, or mucous enduit, which wholly
disappears in many females before the period of accouchement. Several of its
lamellsc are glued to the outer surface of the amnion, principally at the root of
the umbilical cord." p. 53.
Between this reticulated body, as M. Velpeau terms it, (corps
reticule,) and the allantoid of oviparous animals, he thinks there is
the greatest analogy. Yet the fluid of this body is very differeat
402 Velpeau's Embryology^ or Human Ovology, fyc,
from the urine, supposed by some to exist in the allantois of animals.
His idea is, that it is inservient, like that of the umbilical vesicle,
to the nutrition of the foetus at an early period. The inner surface
of the lamellae which he examined was covered by an adherent layer
of the cream-like matter contained in its interior^ and, when examined
by the microscope, its parietes had a villous appearance, so that he
conceives it to be probable, that the substance of the '* corps reticuW^
is secreted by its own parietes.
" I may further remark," he adds, "that this matter preserves its cream-
like, flocculent appearance; its resemblance to an emulsive oil; its characters
of a nutritive substance, until the ovule becomes fixed to the uterus, and after-
wards rapidly disappears to make way for the albuminous layer, which has to
continue until the last stage of pregnancy. In short, since everything leads to the
belief, that the cribriform or reticulated body is analogous, in the human sub-
ject, to the allantoid of other vertebrated animals, and as, in the ophidian rep-
tiles, birds, and the mammalia, the matter inclosed by that pouch is far from
resembling urine, we may, I think, affirm, that there is an allantoid in the hu-
man ovum.'*
After all, our ideas regarding this vesicle in man — if it exist at
all — are far from being determinate; and this remark applies still
more forcibly to the erythroid vesicle^ described by Dr. Pockels of
Brunswick, which is not usually admitted by the obstetrical anato-
mist. Velpeau asserts, that he has never been able to meet with it.
The last chapter of this section of M. Velpeau's work concerns the
organs of circulation of the foetus, regarding some of which much
interesting speculation of an anatomical and physiological character
has been indulged of late.
With regard to the umbilical cord, he asserts that anatomists are
incorrect in stating that the cord does not begin to be formed until
after the first month of gestation. The youngest embryo he had an
opportunity of dissecting had a cord. At a fortnight, and three weeks
old, the dimension is three or four lines; and he thinks his examina-
tions lead him to infer, that at every period of foetal development,
the length of the cord is nearly equal to that of the body, " if it does
not exceed it a little." Prior to the third month, it is irregular,
owing to numerous enlargements; but in this month, owing to the
absence of these, its bulk becomes much diminished. After this
period, it increases in a ratio with the other parts of the foetus, until
the full period of gestation.
Its composition is by no means the same at every period of its evo-
lution. At first, it seems to be nothing more than a small, solid cy-
linder, to which the amnion does not yet furnish a sheath. After
the fifth week, it contains, besides the duct of the umbilical vesicle,
Velpeau's Embryology^ or Human Ovology, ^c. 403
the omphalo-mesenteric vessels, and a portion of the urachus, or of
the allantoic!, and of the intestines. At about two months, the diges-
tive canal enters into the abdomen. The urachus, the vitelline canal,
and the vessels become obliterated, so that at three months, as at
nine, the umbilical stalk or cord is formed only of two arteries, and
a vein of the same name, of the jelly of the cord, or of Wharton or
the spongy tissue of Rouhault, and the membranous sheath, fur-
nished by the amnion and chorion. Wrisberg, Schreger, and
MicHAELis have admitted lymphatic vessels in the cord; Chaussier,
DuRR, RiECK, and others, nerves proceeding from the solar plexus;
but M. Velpeau thinks it probable, that these authors were misled by
some remains of the urachus, of the omphalo-mesenteric vessels, and
of the vitelline canal, &c. ; at least, he affirms, he has never been
able to verify their assertions, notwithstanding all his care has been
directed to the examination, and in this he is confirmed by Lobstein
and Meckel. Here again we have to deplore the inexactness of that
which ought to be exact; and the mind is necessarily compelled to
remain in doubt, unless it will pin its faith to the sleeve of one ob-
server rather than another, which is too frequently the case amongst
both students and teachers. Instead of waiting for the results of
fresh experiments, the verba magistri are too potent for them to re-
sist; and, as in other cases, in place of searching after truth, they be-
come abettorg and partisans, and further inquiry is looked upon as
idle.
We have already remarked, that according to the views entertained
by M. Velpeau of the decidua, and the decidua reflexa, no part of this
membrane can exist between the placenta and the uterus. The foetal
surface is, in his view, enveloped by the amnion and chorion, whilst a
"simple pellicle" covers the maternal surface, and unites its different
reliefs. Whilst it is attached to the uterus, this surface is regular,
and exhibits neither grooves nor orifices of sinuses; but when the pla-
centa is extruded from the womb its surface is extremely unequal.
Lobes of various sizes are perceptible, separated by grooves of greater
or less depth; and these appearances are owing, he says, to the
uterus rolling the placenta upon itself, to detach and expel it, and
thus tearing the thin and anorganic pellicle that concealed the in-
tervals between its numerous cotyledons.
It is well known, that until of late almost every obstetrical anato-
mist adopted the division of the placenta into two parts, constituting,
as it were, two distinct placentae — the one maternal, the other fcetaL
Messrs. Lee and Radford have, however, contested this point, and
have affirmed, with M. Velpeau, that the human placenta is entirely
404 Velpeau's Embryology^ or Human Ovology, SfC.
foetal. The very fact, indeed, of the existence of a membrane, or —
as our author calls it — a membranule^ between the placenta and the
uterus, destroys the idea of any direct adhesion between the placenta
and uterus.
Of the arrangement of this membrane we will allow M. Velpeau to
speak for himself.
" This membranule, which covers the fangous surface of the placenta, ad-
mitted by Arantius, Littre, Hunter, Lobstein, Chaussier, Meckel, and almost
every modern anatomist, but rejected by Ruysch, Mery, Rouhault, &c. it seems
to me, has been generally, but imperfectly understood.
** Some have thought, contrary to the opinion of Wrisberg, that it is only a
very thin portion of the decidua. Many vessels furrow it according to the ma-
jority of observers. Others think that it passes from one lobe of the placenta to
another, without penetrating into the intervals. A yet greater number pretend,
on the contrary, that it dips at the same time between the cotyledons, between
each fasciculus, and each vascular filament. Lastly, there are those who be-
lieve in its existence during the whole course of gestation, whilst many others
affirm, that they have only met with it in the last three or four months.
" Whilst the placenta does not yet form a compact mass, there is no vestige
of the layer in question. After the tomentous groupes of the chorion are
wholly agglomerated, it appears, on the contrary, to veil, as it were, their sum-
mits, and it is soon seen continuous, and confounded with the circle of reunion
of the double reflexion of the anhistous membrane. It certainly does not con-
tain vessels; and the idea of a circular venous sinus, which, on the assertion of
certain anatomists, exists at the circumference of the placenta, can only be the
fruit of inattentive observation.
*' The utero-placental feuillet is arranged in this respect, like the arachnoid
of the brain. On a level with the projecting portions, its adhesion is close,
whilst opposite the interlobar anfractuosities, it may be always detached under
the form of a delicate and transparent lamella. Like the arachnoid, too, it re-
mains at the surface, and does not generally penetrate into the parenchyma.
Its nature is similar to that of the pellicles, which envelope almost all fibrinous
concretions, immediately after their formation. It is not a tissue. Placed in
water, it is destroyed, dissolved, in a few days, with the same facility as every
other raembraniform concretion.
" A layer of deposit, fcouche de dSputtJ much thicker, more fragile, and less
regular than the preceding, surrounds all the vascular trunks. This has given
rise to the belief, that the vessels of the placenta ramify even in the substance
of the decidua; that the chorion is composed of several layers; that the anhis-
tous membrane sends a layer over the external surface, and another over the
foetal surface of the placenta, and that the minute pellicle of the latter is folded
between every fibril of its lobes and lobules. The lamellae, of which it is com-
posed, appear to me to be the product of a particular exudation from the womb,
the chorion, and its tomentous fasciae. In this respect they bear some analogy
to the decidua, from which, however, they diflner in this, that they are not evi-
dent until a long time after the arrival of the ovum in the uterus, whilst the an-
histous ampulla forms immediately after fecundation; and whilst one enjoys great
Velpeau's Embryology y or Human Ovology, fyc. 405
suppleness, and a certain degree of elasticity, the others are dry, hard, and
break almost as readily as glass.
" Perhaps, however, there is here rather a dispute of words, than a differ-
ence of sentiment as regards things. The uterine exudation, which gives
birth to the decidua, seems to me to be producible as well by the outer
surface of the ovule or its villoslties, as by the interior of the Fallopian
tube. Extra-uterine pregnancies afford proof of this. The anhistous layer,
which at that time surrounds the product of conception, has not certainly pro-
ceeded from a mucous membrane. Now this layer, which only differs from
the decidua by its less cohesion, is almost wholly like that found on the pla-
centa, on the placental portion of the chorion, and which agglutinates all the
fibrils of the vascular parenchyma. With such an arrangement we may con-
ceive, that the placenta appears to be continuous with the decidua, and even
covered by it; that its outer pellicle has been described by M. Bojanus under
the name of secondary decidua^ decidua serotina, and that all the concretions,
which interlard its different parts, admit of being derived from the primitive
anhistous membrane, although they are really distinct from it." p. 66.
Until of late, anatomists have described large vessels passing directly
from the uterus to the placenta, and the rupture of these vessels has
been presumed to give rise to uterine hemorrhage. Recently, LeEj
Radford, and Millard, have denied that any such distribution ex~
ists. They, however, admit a decidua between the uterus and pla-
centa, and affirm, that small vessels pass between the uterus, decidua,
and placenta. M. Velpeau, we have seen, does not allow the exist-
ence of a decidua, but admits an interposed pellicle. He denies,
however, that any utero-placental vessels, exist in the generality of
cases.
The mode in which the placenta is developed, is commonly supposed
to be as follows: — When the ovule has descended into the uterus,
the villi of its outer surface are elevated, and traverse the decidua,
to become attached to the uterus, and in this way the placenta re-
sults. These villi, which are at first distributed regularly over the
whole surface of the ovule, soon group and collect at one part, whilst
at every other, the ovule becomes smoother and transparent. The
placenta, however, is not distinguishable until the end of the second
month, at which time it covers two-thirds, or at the least half of the
ovum, and its relative width becomes less, in proportion as the preg-
nancy is more advanced.
The explanation of Velpeau, founded upon his views regarding the
decidua, and decidua reflexa, is different. He affirms, that after the
villous ovum has glided between the uterus and the decidua, and be-
come fixed to the organ, which has to contain it during the whole
period of gestation, it remains in contact with it by one-half, whilst
the other depresses the anhistous membrane, (decidua.) A disk of
406 Velpeau's Embryology, or Human Ovology, fyc.
the ovule necessarily exists, which is not separated from the uterus
by any membrane, and there the placenta becomes developed. He
thinks, moreover, that the placenta commences, in some measure,
with the arrival of the ovule in the uterus, and that its dimensions,
compared with that of the ovum, are nearly the same from the com-
mencement to the end of its development.
One part of this explanation appears to us to account most satis-
factorily for the fact of the placenta being formed so. frequently near
the cornua of the uterus, instead of over the os uteri as it would ap-
pear it ought to be, if the ovule fell from the Fallopian tubes into the
cavity of the decidua, according to ordinary belief. The statistics
of obstetrics, adduced by M. Velpeau, further confirm his view. Of
thirty-four females, who died in a state of pregnancy, or recently
delivered, at the Hopital de Ferfectionnement, an examination of the
parts exhibited, that in twenty the centre of the placenta corresponded
to the orifice of the Fallopian tubej in three it was anterior to it; in two
posterior,* in three beneath, and in six near the fundus of the uterus^
The mode in which the placenta is attached to the uterus has been
an interesting question with physiologists, and it has been revived of
late by Messrs. Lee, Radford, &c. and by our author. The common
opinion has been, that the large venous canals of the uterus are un-
interruptedly continuous with those of the placenta. Wharton and
Reus, and a number of others conceive, that at an early period of
pregnancy the part of the uterus in contact with the ovum becomes
fungous or spongy, and that these fungosiiies, which constitute the
uterine placenta, commingle and unite with those of the chorion so
intimately, that laceration necessarily occurs when the placenta is
extruded; and Dubois goes so far as to consider the milk fever as a
true traumatic disease, produced by such rupture! but it would be a
waste of space to dwell on the different idle speculations that have
been indulged on the subject.
The opinion of M. Velpeau, and of Messrs. Lee, Radford, &c. is,
that the maternal vessels do not terminate in the placenta; but that
apertures — portions scooped out, as it were — exist in their parietes,
which are closed up, according to the latter gentlemen, by the deci-
dua;— according to M. Velpeau, by the membranule or anorganic
pellicle, which, as we have seen, he considers to cover the uterine
surface of the placenta, or by some valvular arrangement, the nature
of which has yet to be discovered; but these apertures have no con-
nexion, in his opinion, with any vascular orifice, either in the deci-
dua or placenta. Under these views, if uterine hemorrhage should
take place, owing to a separation of the placenta, it would probably
Velpeau's Embryology^ or Human Ovology, Src. 407
be, because the plug to the apertures in the sides of the maternal
vessels had been thus removed.
The mode in which these authors consider the placenta to be at-
tached to the uterus is, so far as it goes, somewhat unfavourable to
the idea generally entertained, that the maternal vessels pour their
blood into the maternal side of the placenta, whence it is taken up
bj the radicles of the umbilical vein. Whatever blood is exhaled
must necessarily pass through the decidua, according to Lee and
Radford, or through the pellicle, according to Velpeau. The last in-
dividual thinks, that no blood, in the state in which it is in the ma-
ternal vessels, proceeds directly to the placenta, but that it expe-
riences first of all some elaboration, and the reasons he assigns for
this belief are the following: —
"If we were to persist to consider that the fcetus receives blood ready form-
ed from the mother, all we could affirm would be, that this fluid enters the
placenta by simple porosities, by a sort of imbibition, which might be explained
by a simple continuity of surface. To this I could have no objection to offer,
did the blood appear to pass at any time in its ordinary state to the ovum.
It certainly does not, in the earliest periods at least, for the shag-gy chorion does
not contain vessels until a later period, and the filaments are never hollow as
far as their extremities. On the other hand, the experiments of Autenrieth,
and my own show, that the blood of the foetus has not the appearance of that of
the mother. It is at first rose-coloured, then it becomes more red, then black-
ish, and presents no difference of colour in veins or arteries. M. Tiedemann
and others have noticed, that it contains a much greater proportion of serum
than in the adult, and that it is less coagulable. Every thing, in short, proves that
its chemical composition is very unlike that of the blood of the mother. Even
if chemistry had not exhibited these differences, we should have been com-
pelled to believe that this fluid, like food, requires to be adapted to every age—
fcEtal or extra-uterine, and that the blood of an adult female would be in some
measure a poison for so frail a being as the embryo, or the foetus. If it were
useful to insist on this point, I might add, that according to the microscopical
experiments of MM. Prevost and Dumas, the globules of the blood are so small
in the foetus, that it would not be possible for those of the adult to traverse the
same canals, and the same orifices, without disturbing the equilibrium of the
functions, and immediately producing death. If, therefore, the blood is poured
into the cells of the placenta, or taken up by the porosities of that organ,
it must at least undergo an elaboration, an important modification, before en-
tering the umbilical vein. But what is the nature of this modification? I know
not." p. 74.
This leads us to glance at the deeply interesting subject of foetal
nutrition, respecting which there is such difference of sentiment as to
exhibit clearly, that much respecting it is yet uncertain: whilst many
points have a sort of traditionary authority, that prevents them from
408 Velpeau's Embryology, or Human Ovology, fyc.
being dulj sifted, and examined, but regarding many of which, it
seems to us, a well-founded scepticism maj be indulged.
One of the least tenable hypotheses, that have been entertained re-
garding the embryo at its first formation, is, that for the first month —
and why the period is thus limited is not apparent — the vitality of
the foetus is not independent, but is a part, as it were an offset, of
that of the mother; that it has no separate powers of existence; no
faculty of self-evolution; and that its organs are nourished by the
plastic materials, which it incessantly derives from the maternal
blood.
It appears to us manifest, that from the very moment of the union
of the materials furnished by both sexes at a fecundating copulation,
the elements of the new being must exist, and it must possess within
itself the faculty of self-evolution; otherwise, how can we understand
the phenomena that take place in the ovarium after fecundation? It
is admitted, that this last organ furnishes the unfecundated ovum,
and that the sperm must come in contact with this ovum; after which,
fecundation is accomplished, and immediately the ovum undergoes a
further development, escapes from the viscus in which it was formed,
is laid hold of by the Fallopian tube, passes through this canal, and
is deposited in the interior of the uterus, with which it ultimately
contracts adhesions.
But all this requires time. The ovum does not probably reach the
uterus, itn the human female, until after the expiration of a week —
more or less — and some time must elapse before such adhesions are
effected, and consequently before any thing like maternal blood,
whence the plastic materials are derived according to the view in
question, could be sent to it. During the whole of this time, the
embryo doubtless derives its nourishment from the albuminous matters
with which it is surrounded in the ovum itself, in the same manner
as the young of the oviparous anim-al obtains the nutriment, necessary
for its full development during incubation, from the matters surround-
ing it; in which case the supply of fresh plastic materials, derived
from the maternal blood, is obviously impossible. But in due time
after it has attained the interior of the uterus, it is compelled to ab-
sorb appropriate nutriment from the mother; the minute quantity ex-
isting in the ovum, at this early period, being totally insufficient for
the development which the foetus is destined to attain. In this res-
pect the human ovum differs from the eggs of oviparous birds, which
are hatched out of the body, and contain nutriment enough for full
foetal evolution.
Velpeau's Embryology, or Human Ovology, ^^c, 409
Since the time of Hippocrates, Aristotle and Galen, different
anatomists and physiologists have asserted, that the umbilical vein is
the only channel through which nutriment reaches the foetus; or, in
other words, that the whole of the nourishment which the foetus re-
ceives is from the placenta, but the facts, to which allusion has al-
ready been made, are sufficient to overturn this hypothesis. It is im-
possible, that the placenta can have any agency before it is in exist-
ence. The umbilical vein cannot transmit fluids until it is in esse.
Such an explanation of the process of nutrition could only hold good
after the first periods, and then, as we shall see, it is sufficiently
doubtful. Accordingly, we find that some of the most distinguished
of modern physiologists, who have devoted their attention to embry-
ology, have completely given up the notion of any placental agency
during the first months, and they who have invoked it at all have
usually done so as regards the after periods only.
On all this subject, however, we have the greatest diversity of views.
Lobstein, for example, affirms, that the venous radicles of the rudi-.
mental placenta obtain nutritive fluids from the mother during the
first days only, until the period when the arteries are formed ; but
after this all circulation between the uterus and placenta ceases, and
the umbilical vesicle, the liquor amnii, and the jelly of the cord are
the sole organs of nutrition. Meckel thinks the placenta is never the
source of nutritive materials. He regards it — properly we think — as
an organ for the revivification of the blood of the foetus, analogous to
the organ of respiration in the adult; whilst nutrition is, in his opi-
nion, accomplished by the matter of the umbilical vesicle in the begin-
ning, by the liquor amnii until mid-term, and by the jelly of the cord
until the end. According to Beclard, nutrition is effected during
the first weeks by the fluid of the umbilical vesicle; afterwards, by the
liquor amnii, and the jelly of the cord; and, as soon as the ovum be-
comes villous, and developes the placenta, by that organ.
Adelon, again, is of opinion, that two sources of nutrition ought
alone to be admitted; — the umbilical vesicle, which is the sole agent
for nearly two months; and the placenta for the remainder of the
period. Lastly, M. Velpeau, in the work before us, equally thinks,
that the nutriment of the ovum is derived from different sources at
different periods of gestation.
*'It, (the embryo,) is at first but a vegetable, imbibing the surrounding
humours. The villi of its circumference — true cellular spongioks—ohta.in nutri-
tive principles in the tube and uterus, to maintain the development of the ve-
sicles of the embryo; after which the embryo is nourished like the chick in ovo,
or rather, like the plantule, which is at first altogether developed at the ex-
No. XXVIIL— August, 1834. ' 55
410 Velpeau's Embryology, or Human Ovology, fyc.
pense of principles inclosed in its cotyledons. It gradually exhausts the vitel-
line substance contained in the umbilical vesicle. The emulsive substance of
the reticulated sac or of the allantoid pouch is also gradually absorbed. The
end of the second month arrives. The vessels of the cord are formed. The pla-
centa is unfolded, and is soon sufficient to keep up the evolution of the foetus.
By its contact with the organ of gestation, the spongy cake obtains from the
uterus reparatory materials; works them up; and forms from them a fluid, more or
less analogous to blood, and this fluid is absorbed by the radicles of the umbilical
vein. In a word, the ovule, or the placenta obtains materials from the uterus for
the formation of the fluids of the foetus, as the liver, the kidney, the seminal gland,
8cc. obtain from their own vessels materials for the formation of bile, urine and
the prolific liquor; and as trees and plants extract from the soil the principles
of the numerous compounds they contain. I see nothing difficult of compre-
hension in all these acts. Moreover, the villosities of the chorion, which, to
make use of an expression of M. Seller, are at first but suckerSy possessing a
fungiform character from their extremity to the end, constitute an instrument
of absorption for the whole period of foetal life, and would of themselves suffice
to overturn all the hypotheses, based on the pretended vascular continuity of
the uterus with the placenta." p. 74.
We find, consequently, some of the most distinguished physiologists
of the age denying — as it would seem that every one ought to deny-—
that the nutrition of the foetus takes place solely by means of the blood
sent by the mother to the foetus. If we search into the evidence
aSbrded us by transcendental anatomy, we find, that amidst the
various singular monstrosities met with, there would appear to be
but one thing absolutely necessary for foetal development — an absorb-
ing surface surrounded by a nutritive substance that can be absorbed.
Head, heart — every thing, in short, except organic nervous system^
vessels, and cellular tissue — may be wanting, and yet the foetus will
grow so as to attain its ordinary dimensions.
We have the most incontestable evidence, that a foetus may be
born alive, without umbilicus, umbilical cord, or any evidence of vas-
cular connexion between it and the mother. In noticing the varieties
met with in the umbilical cord, M. Velpeau refers to many such cases.
Thomas Bartholin, during his travels in Italy, saw an individual,
forty years old, who was born without anus, penis, or umbilicus^ and
M. Velpeau cites cases from Ruysch, Samson, Chatton, Rommel,
Denys, Fatio, V. Geuns, Sue, Penchienati, Franzio,Desgranges,
Kluyskens, Pinel, Mason, Osiander, Dietrich, Froriep, and
Voisin, but as these cases militate against his views of embryotrophy,
he attempts to diminish their force by affirming —
" That the observations which he has made, satisfy him, that all the foetuses
thus born had died in utero, in consequence of the destruction of the cord, or
the closure of the umbilicus; or else that the umbilicus existed, but was hidden
Velpeau's Embryology, or Human Ovology, Sf'C. 411
or lost in the extroversion of the bladder, almost always remarked in those that
had lived."
Passing bj the strange deduction of M. Velpeau, — that his *' obser-
vations" have satisfied him of the incorrectness of observations made
by men, who have long since passed away,— long before he existed, —
as well as the facts, that certain of the animal kingdom breed their
young without placenta or umbilical cord, and that the foetus, in extra-
uterine pregnancies, has frequently no placenta, — the case given by
Hoffmann, and cited by Dr. John Mason Good, of a foetus born in
full health and vigour, with the funis sphacelated, and divided into
two parts, — and a case observed by Dr. Good himself, appear to us
to be impregnable. The case in question occurred to Dr. Good in
1791. The labour was natural; the child, scarcely less than the
ordinary size, was born alive; cried feebly, once or twice afterbirth,
and died in about ten minutes. The organization, both internal and
external, was imperfect in many parts. There was no sexual charac-
ter whatever; — neither penis nor pudendum, nor any interior organ
of generation. There was no anus or rectum; no funis; no umbilicus.
The minutest investigation could not discover the least trace of any.
With the use of a little force, a small, shrivelled placenta, or
rather the rudiment of a placenta, followed soon after the birth of the
child, without a funis, or umbilical vessels of any kind, or any other
appendage by which it appeared to have been attached to the child.
In a quarter of an hour afterwards, a second living child was pro-
truded into the vagina, and delivered with ease, being a perfect boy,
attached to its placenta by a proper funis. The body of the first
child was dissected in the presence of Dr. Drake, of Hadleigh, and
of Mr. Anderson, of Sunbury, to both of whom Dr. Good appeals
for the correctness of his statement.
Transcendental anatomy, then, instructs us, that placenta and
umbilical cord are not indispensable to foetal nutrition; and compels
us to infer, with Meckel, one of the most eminent teachers of anatomy
and physiology — in all their bearings — of modern times, that the
human placenta may have no direct agency in embryotrophy. We
are necessarily therefore driven to the conclusion, before laid down —
that in orde?r that a foetus shall be produced in utero it is but neces-
sary, that there shall be an absorbing surface surrounded by a nutri-
tive substance that will admit of being absorbed. Now, the cutaneous
envelope of the foetus — monstrous or natural — is such a surface, and
the liquor amnii such a fluid; whilst the matter of the umbilical vesicle,
and the jelly of the cord, when these parts exist, and possibly some
material derived through the placenta — after it exists — may lend their
412 Velpeau's Embryology^ or Human Ovology, SfC.
aid. But the participation of the last organ is — to say the least-
doubtful. Its function is probably to admit of the foetal blood being
shown to that circulating in the maternal vessels, so that some change
may be eft'ected in the former, which may better adapt it for serving
as the pabulum, whence the secretions, from which the foetal organs
have to be elaborated, must be formed. We cannot, however, pursue
this deeply interesting subject further.
The second and last section of the work comprises two chapters —
the one on the formation of the embryo, the other on the successive
development of its different parts. In neither do we find much on
which to comment.
The appearance of the embryo, when it can be first detected, is of
course a matter of observation, yet the evidence of dift'erent observers
is most discordant. M. Velpeau does not attempt to say what is its
primitive form, but his observations have satisfied him, that the spine
is the fundamental part of the body; that it appears before any other
organ; that it exists alone for an appreciable time; that its shape is
not essentially diiFerent from what it is at other periods of intra- uterine
life; that at twenty days and some days afterwards, it is not straight,
nor is it larger in the middle; that the head and the neck form at least
one-half its length; that its curvature is the nearer to a circle the less
its development; and that the appearance of its circumference differs
but little from what it presents afterwards —
" Whilst its anterior contour or its concavity merits the most serious attention
by the changes which it experiences; on it the different organs being succes-
sively developed." p. 78.
In the desire for generalization, which has possessed the minds
of many of the modern anatomists and physiologists — of Germany and
France more especially — it has been attempted to show, that every
human foetus, at its earliest periods of development, is alike as re-
gards its sexual organs, and that it has ultimately the characteristics
of one or the other sex, according to circumstances often perhaps ad-
ventitious. This view has been suggested by the impracticability of
distinguishing the sex, until a certain degree of development has been
attained. For example, at the end of the fifth week, a small, cleft
eminence is apparent, which is the rudiment of the scrotum or the
vulva, according to the sex. At the sixth, a small black point is per-
ceptible in front of the coccyx, which marks the anus, or the aperture
common to the anus and genital organs. A little nearer the umbilicus,
a conical tubercle is perceptible, connected at its inferior part. This
forms the rudiment of clitoris or penis, according to the sex. About
the seventh or eighth week, this tubercle appears to be surmounted
Velpeau's Embryology^ or Human Ovology, Sfc. 413
by a glans. At the eleventh or twelfth the perinseum forms, so as to
separate the anus from the genital organs. At the fourteenth the
sex is marked.
This striking similarity between the male and female organs has
led M. TiEDEMANN to conclude: — that the female sex is the male,
arrested at an inferior point of organization. According to him, every
embryo is primitively female; — the cleft, above-mentioned, being the
vulva; and the projecting tubercle the clitoris. To constitute the
male sex, the cleft of the vulva is united to form a raphe; the labia
majora when joined, form the scrotum; the nymphae, the urethra; and
the clitoris is converted into a penis. In support of this opinion, M.
Tiedemann affirms, that the lowest species of animals are almost all
females, and that all the young acephali and abortions, which he has
examined, were so likewise.
On the other hand, Ackermann and Autenrieth assert, that the
sexes are originally neuter; whilst M. Velpeatt is disposed to believe,
that they are all male! the infra-pubic prolongation existing in every
embryo, although there may be neither labia majora, nor scrotum,
p. 82.
But granting with any of these speculatists, that the embryo be-
longs to either one or the other sex, or is neutral, we must still re-
main at a loss regarding the influences that occasion the subsequent
mutations; and it seems impossible not to admit, that, although an
apparent sexual identity may exist amongst different embryos, there
must be an impulse, seated somewhere, which gives occasion to the
sex being ultimately "male or female, as it causes the young being to
resemble one or other parent in its outward form, or internal confi-
guration; and, if our means of observation were adequate to the pur-
pose, a distribution of arteries or nerves might probably be detected,
which would satisfactorily account, ah initio^ for the resulting sex.
In the absence of such positive data, M. Geoffroy St. Hilaire has
suggested that the diff'erence may be owing to the distribution of the
two branches of the spermatic artery. If these branches remain in
approximation, and proceed in concert — the one to the testicle, the
other to the epididymis — the individual is male; if, on the contrary,
they separate — the one going to the ovary, the other to the correspond-
ing cornu of the uterus, the individual is female. The degree of pre-
dominance of the cerebro-spinal system occasions the approximation
or separation of these two arterial branches. This predominance be-
ing stronger in the male, the spermatic arteries are more feeble, and
consequently in greater proximity; and vice versa. But all this, it need
scarcely be said, is pur« hypothesis.
35*
414 Velpeau's Embryology, or Human Ovology, 8fc,
Since writing the above, we have received Dr. Granville's splen-
did '* Graphic Illustrations of Abortion, and the Diseases of Men-
struation," the text of which bears almost wholly on the subject of
embryology; the plates being mainly intended to elucidate a forth-
coming publication by the same author. We can, therefore, at no
time bring it before the attention of the profession better than at
present.
Conception Dr. Granville properly considers to be accomplished
in the ovarium. The evidence in favour of this view of the subject is
indeed overwhelming; yet we have such eminent physiologists as
Meckel, and Prevost and Dumas doubting it. The ovulum, when
it descends into the uterus — Dr. Granville asserts, on the authority
of Professor Boer, of Konigsberg — has an external membrane enve-
loping it, which Boer calls the " cortical membrane," and the author
" cortex ovi." This membrane they describe as the one which, we
have seen, is usually regarded as a uterine production, and denomi-
nated the decidua reflexa — the reflected caducous or deciduous mem-
brane.
He consequently denies that there is any such thin^ as a decidua
reflexa — an opinion which has been embraced, but upon other grounds,
by many obstetrical inquirers, and amongst others, by Professor De-
wees, to whom we are pleased to see Dr. Granville offer the merited
tribute, of being "as skilful and clear-sighted an obstetrical writer of
the United States of America, as any that have appeared in Europe."
p. v.
In two of the specimens of abortion, which are figured in the pre-
sent work, there are strong evidences of the existence of this cortex
ovi, which envelopes the shaggy chorion. This cortical membrane is
destined to be absorbed during the first months of utero-gestation,
so as to expose the next membrane to the contact of the decidua,
with which a connexion takes place in the part where the placenta is
to be formed.
" In that part, however, the cortex ovi is never altogether obliterated, but
only made thinner; and in process of time it is converted into a mere pellicle
or envelope, which not only serves to divide the filiform vessels of the chorion
into groups or cotyledons in order to form the placenta, but also covers all
over those cotyledons or groups of vessels. I have called this the membrana
propria.^* p. iv.
Dr. Granville thinks it probable, that the decidua consists of two
laminae, " inasmuch as we always find it with one surface perfectly
smooth, and the other rough."
The ovulum, on entering the womb, is about the size of a small
Yelpeau's Embryology ^ or Human Ovology, Sfc, 41 5
pea. The time at which it emerges from the Fallopian tube is not de-
termined.
^* It is said to have been detected in the uterine cavity on the eighth day,
(Home.) Although it has lately been the fashion to doubt the accuracy of such
a fact, there is reason to believe it to be correct, from the circumstance of M.
Bauer's microscopic examination of the ovulum, and description of its struc-
ture corresponding with more recent discoveries, (Boer.") p. vii.
After the ovulum is lodged within the cavity of the womb, it con-
tinues to grow on its own '' life-principle," until its connexion with
the mother is effected, through the medium of the deciduous mem-
brane, which becomes, at a more advanced period, as it were, a new
and additional covering to the ovulum. The growth of the ovulum
causes the cortex to burst, as happens with the receptacle or cortex
of certain seeds, and with the outer shell of the ova of some ovipa-
rous animals.
On the cortex bursting, the fibrils of the chorion entwine them
selves with the flocculi of the decidua, and thus the ovulum fastens
itself to the uterus by one or more contiguous points. These fibrils
are not all vessels. Some are only suckers; others are real vessels.
**The existence of any vessels among the fibrils of the chorion has been de-
nied very recently upon the same ground, namely, microscopical observations.
(Breschet and Raspail.) But there must be an evident mistake in such observa-
tions: for the actual progress of those filiform vessels, and their gradual swell-
ing into large veins and arteries, at an advanced period of foetation, have been
noticed in examining various human ova of different ages. (Lobstein, Velpeau,
Dutrochet, and myself.")
The chorion he affirms to be bifoliated, and he thinks, with Dutro-
chet, it is probably even trifoliated. Its vascularity is proved by its
diseases, chiefly of an inflammatory character, ending in thicken-
ing of its texture, of which he gives several examples with graphic
illustrations; and he affirms, that there is a preparation in the collec-
tion of Sir Charles Clarke, which shows the vessels of the chorion
as evidently as if they had been injected.
In like manner, although normal anatomy may have failed in show-
ing the amnion to be vascular, pathological anatomy, he asserts, has
succeeded, and has shown that it may be a secreting membrane.
The amnion he considers to be a sac formed by the reflected layer
of the epidermis of the embryo, and he quotes Velpeau and others in
support of the opinion; but Velpeau, we have seen, although he once
thought so, now disclaims the notion.
On the mooted question, whether the arteries or nerves appear
416 Velpeau's Embryology, or Human Ovology, ^^c.
first, Dr. Granville accords with those who give precedence to the
vascular system. " The nerves invariably appear after the arteries
which they are intended to accompany." Yet the experiments of
Home, and of Prevost and Dumas, lead to reverse conclusions. The
same dissidence exists with regard to the precedence in formation of
the blood-vessels. The blood is formed independently of the heartj
the veins, according to the generality of physiologists, first appear;
next the heart, and then the arteries. A distinguished Italian phy-
siologist, however, (Rolando,) assigns the precedency to the arte-
ries. Further experiments are demanded to settle these interesting^
but intricate points of organogenia.
Of the umbilical, allantoid, and erythroid vesicles, he gives us
nothing new, and nothing from personal observation.
On the interesting subject of utero-foetal circulation, Dr. Granville
is enthusiastically in favour of a utero-decidual circulation. He
thinks the fact of the existence of vessels passing between the uterus
and decidua unquestionable; but these he makes independent of the
foeto-placental circulation. His view of the functions of the placenta
are precisely those which we have given in the former part of this
review.
*'90. The circulation of the blood in the ovum is independent of that of the
mother, (personal experiment (59) and all the more recent physiologists.) The
embryo creates its own blood, and through it sustains its own existence. But
its blood, like that of all other animals, whether during its intra or extra-uterine
life, requires to undergo certain changes at every minute period of that life,
and those changes it experiences through the influence of the blood of the
mother. (Magendie, Mende, Pockels, Baer, Chaussier.)
** 91. The function of the placenta, therefore, seems to be to facilitate, and
in good truth to effect the necessary changes in question, (90.) The decidual
vessels receive the arterial blood of the mother. This is spread over a very
considerable surface of tubular structure, which being in its distribution, made
to come in apposition with the infinite ramifications of the umbilical placental
vessels at innumerable points, (like the inspired air distributed through the
bronchial passages, is made to come in apposition with the myriads of vascular
rami of the lungs;) the required changes in the blood of the foetus are produced,
just as the changes called for in the pulmonic blood are produced by the peculiar
arrangement of that part of the animal economy. When the arterial blood of the
mother has produced the desired effect on that of the foetus, it is returned by
decidual veins to the uterine sinuses applied, like absorbing mouths, to the
surface of the decidua, when it enters into the general venous system of the
mother. (Magendie; personal observations.") p. xviii.
On the subject of the nutrition of the foetus, Dr. Granville is ex-
tremely obscure. He does not indeed know how to decide. The
Velpeau's Embryology^ or Human Ovology, <5r. 417
above extract would show, that he considers the function of the pla-
centa to be that of a mere respiratory apparatus; but he quotes the
opinion of Mr. Mayo, that— •
**Itis not difficult to believe, that nourishment is directly imbibed from the
vessels of the mother by the circylating" fluid of the embryo, through the fine
intervening' membranes."
This, however, could only apply to the ovulum after it has con-
tracted an adhesion with the uterus. He is disposed, too, to consider
it probable, with Dr. Hunter, that the foetus may be nourished by
thousands of small lymphatic vessels, which absorb nourishment
from the blood of the mother, and carry it along the navel-string.
He adduces many cogent reasons why the foetus should not be nou-
rished by "a regular deglutition and digestion" of the amnionic
fluid, along with others that are not as cogent, — as where he asserts,
that the liquor amnii is "• mere water with a vestige only of albumen,
the only nutritive quality in it."
The view that ascribes foetal nutrition to cutaneous absorption of
the liquor amnii, and which we have attempted to show, is the most
tenable of all, and unites the greatest amount of evidence in its fa-
vour, is thus cursorily passed over.
** Some have thought that the amnionic fluid was absorbed through the
pores of the skin, (Osiander;) others through the mammae of the foetus, (Oken.)
That the vesicula intestinalis, (umbilicalis,) contributes to the growth of the
embryo is a great deal more probable, (Blumenbach, Soemmering, Lobstein^
Joerg.) It is also not improbable that the gelatine of Wharton contributes to
that object, (Lobstein,) But these are all conjectures, for the probability or
improbability of which as many arguments and real facts have been alleged on
equally unquestionable authority. * Ce sujet,' observes Magendie, *a souvent
exerce Pimagination des physiologistes, sans aucun profit reel pour la science.* '*
p. xix.
In this vague manner he leaves this interesting subjec^. No one
can presume to say, from the perusal of his observations, what he
considers to be the main agents of embryonic and foetal nutrition.
These are the principal topics touched upon in the text of Dr.
Granville's publication, or in what he calls the Prolegomena^ the re-
mainder of the letter press, constituting what he regards as the main
body of the work, being devoted to an explanation of the plates. In
this part of the work he has indulged in the extreme affectation of
classifying his specimens of abortion, as if they were fixed and in-
variable products of animated nature. Thus, we have — as specimens
of very early miscarriages — " Fig. 1. Ovulum bigeminu^n lanugino-
sum»^^ " Fig. 2. Ovulum semi-lanuginosum:^^* — as specimens of mis-
418 Carswell on the Elementary Forms of Disease.
carriages between two and three months — " Fig. 10. Ovum pyri-
forme externe opacum.^^ " Fig. 12. Ovum opacum plethoricum:^^ —
amongst those of miscarriage between the third and fourth month—
''Fig. 18. Ovum coriaceum, cum hydrope funis et placenta hydaticdJ^
" Fig. 19. Ovum cum placenta, nee vasculare, nee plene cotyledonicd,
sed filiforme. Amnion morhosumJ^^ There is, indeed, about the whole
work — beautiful and accurate as are its graphic illustrations — a suffi-
cient appearance of the author's self-satisfaction, and occasionally
too much evidence of something closely approximating to Charlata-
nisme. ^
At the end of his prefatory advertisement, he observes —
** I shall conclude by remarking, that the plates are intended to illustrate a
work **on Abortion and the Diseases incidental to Menstruation," which I have
been preparing for several years, and a prospectus of the contents of which
will be found at the end of the present volume. That work will appear, Deo
favente, in the course of the present year; but for the convenience of such per-
sons as may not feel inclined to purchase it, the collection of plates has been
purposely so arranged, as to be published with a corresponding text, in a sepa-
rate form, and independently of the forthcoming volume."
R. D.
Art. XIII. Illustrations of the Elementary Forms of Disease. By
Robert Carswell, M. D. Professor of Pathological Anatomy in
the University of London, &c. London, 1833. Parts 1, 2, 3.
The labours of the pathological anatomists for the last twenty
years have been developing gradually the diiferent forms of lesion to
which the various textures of the body are liable, under the influence
of morbid action; while the progressive state of physiology and che-
mistry has contributed largely to a correct understanding of their
vital and physical characters, and suggested an accurate and judicious
system of therapeutics. Aided by the efforts of the immortal Bichat,
the pathologist is now enabled to systematize and prove the identity
of lesions, which were formerly regarded as dissimilar in anatomical
and chemical characters. Of the recent contributions to pathology,
none should claim a greater meed of praise than that of Mr. Carswell,
on account of the perspicuity and clearness of its descriptions; the
soundness of its views; the beauty of its illustrations, and its simple,
yet accurate classification. We shall endeavour, as the work is
costly, and consequently must have a limited circulation, to present
Carswell on the Elementary Forms of Disease. 419
our readers with a faithful analysis of the first, second, and third
fasciculi, believing that he would prefer making his own strictures
upon such views as conflict with the prominent authorities on the
morbid degenerations of which they treat. The different opinions
advanced by pathologists upon the primary state of tuberculous mat-
ter, have induced our author to enlarge his definition of it, so as to
embrace many of the apparently adverse observations of equally re-
putable investigators; believing, as is certainly evident, that this di-
versity of opinion has, in many instances, arisen from the stage in
which the examination has been conducted; thus Andral contends
that tubercle at its origin is an opaque, friable, rounded body, of a
yellowish-white colour, and without traces of organization or texture;
while Laennec does not consider this to be the first stage, but that this
is in every instance preceded by a grayish, semitransparent granule. On
the other hand, Cruveilhier infers from his observations, that the
hard, granular body is always a consequence of a puriform fluid; and his
views are sustained by M. Trousseau and La Blanc in their exami-
nations of the lungs of horses; while Dr. Baron and M. Dupuy sup-
pose that it commences as a transparent vesicle or hydatid. Tuber-
culous matter, as defined by Mr. C. is a pale yellow or yellowish-
gray, opaque, unorganized substance, the form, consistence, and
composition of which, vary with the nature of the part in which it is
formed, and the period at which it is examined. Considering tuber-
cle as the product of the perspiratory secretion, Andral contends
that it may be located in every part of the body, but is most usually
found in the cellular tissue. Dr. Carswell, however, contends, that
by far the most frequent development of tubercle takes place in the
mucous tissue, and that whenever it is found in an organ provided
with a mucous membrane, it will have its seat upon that membrane,
thus the mucous system of the respiratory, digestive, biliary, urinary,
and generative organs is much oftener the situation of tubercle than
any other texture which enters into their composition. Our author's
experience is directly adverse to that of Andral; for although the lat-
ter does not deny that tuberculous matter is sometimes found on the
free surface of the mucous membrane, yet he asserts this to be extreme-
ly rare, and that he would be led to believe, that in by far the
majority of instances, when the mucous membrane is involved, the
primary location of the tubercle is in the sub-mucous cellular mem-
brane, and by its gradual increase encroaches upon, and ultimately
implicates it.
Tuberculous matter is frequently formed and diff*used over the free
420 Carswell on the Elementary Forms of Disease.
or secreting surface of the serous membranes in the cellular texture-
and in the blood, and not unfrequentlj accumulates in the lacteals
and lymphatic vessels. The 'fact of tuberculous matter being absorbed
by the lacteals, will be objected to by many physiologists who con-
sidered the office of the lacteal vessels to be exclusively the taking
up and converting into chyle the nutritive particles of the chymous
mass; if, however, the statement of Dr. C. that tuberculous matter is
found in the lacteal vessels be correct, we must consider it as an il-
lustration of his foregoing statement, and view it as a production of
the lining membrane of the vessel itself. The cerebrum and cere-
bellum are sometimes the seats of this mprbid product.
Admitting that tubercle is developed in almost every texture, it is
evident that its form or external configuration must vary according
to its location, and thus the rounded form considered by some patho-
logists as characteristic of this production, is purely accidental, and
is ascribable entirely to the physical constitution of the texture in
which it is located. Thus, from the homogeneous nature of the brain,
and the equal resistance which is opposed to the accumulation of tu-
berculous matter at every point, it is compelled to assume a rounded
form; in the cavity of the air-cells it forms a globular tumour; in the
bronchi a tubular or cylindrical form; while in the biliary system
it has a racemiform arrangement, from its being contained in the
ducts and their dilated bulbous extremities. On the surface of serous
membranes it is either globular or lamellated; in the infundibula,
pelvis, and ureters of the kidneys, it is moulded into the form of each
part, and sometimes it becomes infiltrated, and does not assume a
definite form.
We shall refer the reader to. the following remarks upon the con-
sistence and colour of tuberculous matter, as they embrace the merits
of the controversy between pathologists in relation to what ought to
beconsidered the strict definition of tubercle and its primary state.
** Tuberculous matter does not acquire its maximum of consistence until an
indefinite period after its formation. It is frequently found in its primitive state
in the bronchi, air-cells, biliary ducts, and their dilated extremities, in the cavity
of the uterus and Fallopian tubes, &c. resembling" a mixture of soft cheese and
water, both in consistence and colour; but when much resistance is offered to
its accumulation, as in the lymphatic glands, and even sometimes in the air-
cells of a whole lobule, it may feel as firm as liver or pancreas. These extreme
degrees of consistence of tuberculous matter depend not only on the resistance
which the tissues of these and other parts oppose to its accumulation, but also
on the removal of its watery part some time after it has been deposited. Hence
it follows, that tuberculous matter may, when first perceived, be either very
Garsvvell on the Elementary Forms of Disease, 421
soft, or remarkably firm. In the first case it is pultaceous, and feels somewhat
g-ranular when rubbed between the fing-ers? in the second friable; and in both
it is of a pale-yellow colour, and opaque/'
**The gray semitransparent substance already alluded to, by no means neces-
sarily precedes the formation of the pale-yellow or opaque tuberculous matter?
it is, indeed, observed in a few only of the many organs in which the latter is
found. Thus, it is never seen in the cavity of the uterus or Fallopian tubes;
in the ureters, pelvis, or infundibula of the kidneys; in the mucous follicles of
the intestines; in the lacteals or lymphatics; in the biliary ducts; nor do I recol-
lect to have seen it in the cerebral substance. I have never met with it in the
bronchi, unless in some of their most minute or terminal branches. On the
contrary, the semitransparent substance is frequently seen in the air-cells, and
on the free surface of serous membranes, particularly the peritoneum; and in
both it is certainly sometimes observed to precede the formation of opaque, tu-
berculous matter; because, first, a number of cells of the same lobule are seen
filled with the former, whilst the remaining cells contain the latter substance;
secondly, because on the peritoneum the gray, semitransparent substance is
generally more abundant than the pale-yellow, opaque matter; and thirdly, be-
cause a small nucleus of the latter is frequently enclosed in a considerable quan-
tity of the former. The following is the explanation which I would ofier of
the<se exceptional conditions to the regular and ordinary formation of the tuber-
culous matter. But, first of all, it is necessary to remark, that the formation
and manifestation of this matter as a morbid product cannot take place unless
the fluid from which it is separated — the blood — has been previously modified.
This important fact being admitted for the present, it is obvious that a healthy
secreting surface may separate from the blood not only the materials of its own
peculiar secretion, but also those of tuberculous matter. Such is, indeed, what
takes place in the air-cells. The mucous secretion of their lining membrane
accumulates where it is formed; but it is not pure mucous, it contains a quantity
of tuberculous matter mixed up with it, which after a certain time is separated,
and generally appears in the form of a dull, yellow, opaque point, occupying
the centre of the gray, semitransparent, and sometimes inspissated mucus. This
process of separation of tuberculous matter from secreted fluids is strikingly
exemplified in tubercular peritonitis. When we examine the peritoneum thus
affected, the three following stages of the process are frequently extremely
well-marked; first, on one portion of this membrane there is seen a quantity of
recently-secreted, coagulable lymph; secondly, on another we find the same
plastic semitransparent substance, partly organized, and including within it, or
surrounding a globular mass of tuberculous matter; and lastly, on another
part the coagulable lymph is found converted into a vascular or pale cellular
tissue, covered by an accidental serous membrane, beneath which, and external
to the peritoneal or original secreting surface, the tuberculous matter is seated,
having the form of a round, granular eminence, resembling in colour and con-
sistence pale,- firm cheese."
** In this, as well as in the preceding case, we cannot but perceive that the
formation of tuberculous matter originates in a process similar to that of secre-
tion; that its separation from the blood may be accompanied with that of natu-
No. XXVIII.— August, 1834. 36
422 Carswell on the Elementary Forms of Disease,
ral, and also other morbid secretions; and hence the reason why its physical
characters are sometimes observed, particularly in the first stage of its forma-
tion."
We discover bj the above remarks, that our author does not con-
ceive firmness to be an essential attribute of tuberculous matter, and
that even when it does exist in this form, it is not unfrequently after
some considerable time, and owes its consistence to the removal of
the fluid part of the original deposit. Neither does he believe with
Laennec, that in every instance the primary stage is the gray, semi-
transparent granule. To explain the deposit of this morbid produc-
tion, a heavy draught is made upon the humoral pathology, for while
the blood is presumed to be modified in its qualities, the secernent
apparatus is in a healthy condition, performing its usual function,
elaborating from the blood, besides its healthy secretion, a fluid,
which, when deposited, proves to be the morbid production in ques-
tion. As repugnant as this appears to be to the almost universally
prevailing doctrine of solidism, yet we cannot but admit, that it ex-
plains satisfactorily the deposition of this matter in textures essen-
tially different in vital, chemical, and physical attributes, and the
several stages through which it passes in its gradual development.
When anatomically and chemically examined this matter presents
variety in its composition. In the cheese-like substance alluded to
above, there is not the slightest trace of organization, and it may be
said of tuberculous matter in general, that—
*'It has, in fact, no definite internal arrangement, and the changes of bulk,
consistence and colour which it undergoes, are entirely dependent on the in-
fluence of external agents."
Tested by chemical agents it presents different results in the dif-
ferent stages of its deposit and even in different organs. In man it
is principally composed of albumen, with various proportions of gela-
tine and fibrine, with a portion of the earthy salts, principally phos-
phate of lime; but the most important fact connected with the che-
mical composition of tubercle is, that either from the nature of its
constituent parts, the mode in which they are combined, or the con-
dition in which they are placed, they are not susceptible of organiza-
tion, and consequently give rise to a morbid compound, capable of
undergoing no change that is not induced in it by the influence of
external agents. Thus, when softening of a tubercle takes place it
cannot be accomplished by any change which is effected in the morbid
product itself: from this it would appear that the opinion of Laennec,
that the softening commences in the centre of the mass, is somewhat
Carswell on the Elementary Forms of Disease, 423
doubtful; in this Andral unites, for in examining the mode by which
ripening is accomplished he distinctly disavows any agency of the
tuberculous product itself. In consequence of the texture in which
it is located, the deposit not unfrequently remains fiuid from its
origin, but when it becomes firm the process of softening is attributa-
ble to each particle of the tuberculous matter acting like a foreign
body on the tissues with which it is in contact, produces in each cor-
responding point of these tissues a secretion of pus which mechanically
effects the division of the tubercle into clots, and acts here exactly
similar to a foreign body lodged in any part of the living system.
This separation of the particles of the mass into clots, and ultimately
reduction to a softened mass is the result of a process of irritation not
peculiar to the part, but analogous with the suppurative action esta-
blished by all textures to relieve themselves of some foreign irritant.
Softening commences then most frequently upon the circumference
which is usually recognised as the foreign mass. The existence of
encysted tubercle is strongly doubted by Dr. C. who thinks that the
investing membrane or cyst is in every instance a portion of the tex-
ture in which the matter is found; when located in the lungs he has
demonstrated it to be the distended walls of the air-cells in the
biliary system— the dilated bulbous extremity of the hepatic radicle.
The removal and ultimate cure of tuberculous deposits is consider-
ed of frequent occurrence, and in many instances without ulceration
or suppuration: in scrofulous enlargements of the lymphatic glands,
as for instance, in tabes mesenterica, there has been a removal of the
tuberculous matter, and the patient relieved entirely of the existing
symptoms; and upon examination after death, from other causes, the
mesenteric glands have been found to contain a chalky substance,
the remains of previously existing tuberculation. In this case the
gelatine and fibrine have been removed by the absorbents; leaving
behind the calcareous constituent; a mode of reparation of not very
rare occurrence in the lungs and other organs. Again, the entire
contents of these glands have been evacuated, and converted into a
fibrous tissue. The same appearances indicating the removal of the
serous and albuminous parts of the tuberculous matter, and the con-
densation of its earthy salts, have frequently been observed in the
lungs of persons in whom the previous existence of tubercular
phthisis could not be doubted: but the usual termination of tubercula-
tion of the lung, is eftected by the expectoration of the matter after
it has become fluid.
We now pass on to the heterologous formations, which although
424 Carsvvell on the Elementary Forms of Disease,
they constitute one of the most important and difficult subjects of
anatomico-pathological investigation, and have for a long time occu-
pied the attention of the pathologist, are yet involved in much ob-
scurity, particularly those which are termed malignant — as cancer,
medullary sarcoma, and fungus hsematodes. This imperfect state of
our knowledge is attributable, in the estimation of our author, to the
following circumstances, viz.
*' The almost exclusive study of them for a long period as they occur in the
external parts of the body in the form of tumours, and the partial or inaccurate
observation of their primary forms, of the subsequent changes which take place
in them, and of the modifications which they undergo in these and other res-
pects, in the different tissues and organs of the body."
Much of the difficulty in classifying these morbid productions has
arisen from the reckless and indiscriminate mode of observation pur-
sued by pathologists; for instead of examining the primary state of
these formations with the successive development of their several
stages, they have been content to describe each condition as a new
and distinct morbid lesion, and thus established as separate degenera-
tions the several stages in the development of one and the same pa-
thological condition of the organ; and have given rise to the multi-
tude of names which at present burden this interesting branch of pa-
thological investigation. The essential character of the heterologous
formations consists in the presence of some substance, either solid or
fluid, which does not enter into the healthy composition of the body;
presenting, however, striking differences in one or more of its cha-
racters, which have given rise to the various forms of disease, and
described from their resemblance to the healthy structures of the body
and other substances — as scirrhus, medullary sarcoma, fungus hsema-
todes, melanosis, tubercle, pus and calculus; terms, which we have
stated above, should convey no specific difference in the morbid con-
ditions to which they are applied, and indeed Mr. Carsweil remarks
that the same disease has received different appellatives in conse-
quence of the dissimilarity which is present at different stages of its
development. It is evident then that the number of heterologous
formations can only be determined by ascertaining the primary forms
in which this substance is found, and the subsequent changes to
which it is subject in the different textures and organs of the body.
After a careful and accurate investigation of the primitive forms of
those deposits which have as their essential characteristic some prin-
ciple which does not enter into the organization of the healthy ani-
mal, and the types which they assume in their progress to full deve-
Carswell on the Elementary Forms of Disease. 425
lopment, our author has determined to class them under the terms
carcinoma, melanoma, pyonoma, tjnoma, lithoma. Under the divi-
sion carcinoma we have presented for examination common vascular
or organized sarcoma; pancreatic, mammary and medullary sarcoma;
and fungus hsematodes; although these diseases are generally pre-
sumed to differ essentially in their nature, yet they warrant the
classification adopted, by their presenting in their formation certain
peculiarities common to all of them; by their gradual destruction or
transformation of the textures in which they are located; by a ten-
dency to affect several organs in the body; and lastly, by their pos-
sessing the same reproductive character. These carcinomatous for-
mations differ somewhat from each other, and present us with two
divisions or classes; in one the deposit manifests no disposition to be-
come organized, its form and arrangement depend entirely upon ex-
ternal circumstances: in the other a tendency to organization is
evinced, and in itself possesses properties, by means of which its sub-
sequent development is accomplished, without reference to the nu-
tritive efforts of the organ in which it is located. The first of these
divisions we term scirrhoma; the second, cephaloma. The varieties
of scirrhoma are established by the quantity of the foreign deposit,
and its mode of arrangement; thus when it is distributed in numerous
points of a hard, gray, semitransparent substance, intersected by a
dull white or pale straw-coloured fibrous or condensed cellular tissue,
it is styled scirrhus; if it assumes a lobulated appearance, so as tore«
semble a section of the pancreas, it is termed by Mr. Abernethy
pancreatic sarcoma; if, on the other hand, it is uniformly diffused
through the texture of the organ, so that a section of it resembles a
slice of pork, it is called by the French, tissu lardace; or lastly,
when it resembles firm jelly, and is collected into masses of greater
or less bulk in a multitude of cells, it is termed by Laennec, matiere
colloid, cancer gelatiniforme or areolaire, by Cruveilhier.
The varieties of cephaloma are determined by the appearances
which the heterologous deposit assumes in different organs, or at dif-
ferent stages of its development. Mr. Abernethy termed it common
vascular or organized sarcoma when it resembled coagulable lymph,
or fibrine deprived of the red colouring matter of the blood, of a uni-
form, fibriform or lobuliform arrangement, with a certain degree of
transparency and vascularity: on the contrary, if it was spread equally
throughout a texture, and presented the appearance of a section of
the mammary gland, he called it mammary sarcoma; or when it par-
took of the external characters of brain, he considered it to be me-
36*
426 Cars well on the Elementary Forms of Disease,
dullary sarcoma; Laennec styled the last form matiere cerebriforme,
or encephaloide; Burns, spongoid inflammation; Dr. Monro, the milk-
like tumour; the soft cancer by others; the pulpy testicle of Dr
Baillie. In the last species the coats of the vessels which supply the
tumour are so extremely delicate that they rupture from congestions,
and blood mixed with the brain-like substance is effused; this accidental
circumstance, together with its protrusion through the integuments,
has applied to it the appellation of fungus hsematodes, or fungoid
disease. Our author remarks, that although the essential difference
between these species consists in the former having little tendency
to become organized, and the latter a greater or less disposition to
assume this state; yet, it is extremely difficult to draw an accurate
line of distinction between them, because the heterologous deposit
■when first formed does not display any signs by which we may de-
termine whether it will or will not become organized.
Examples may be adduced to show that scirrhus, medullary sar-
coma, and fungus hsematodes, have been developed from the same
morbid state, and not unfrequently two species present themselves
in the same organ of one individual.
Let it not be inferred from these remarks that it is unimportant to
distinguish one species or variety of this disease from another; since
one will readily run into another still more inveterate; for the cura-
bility of the disease often depends upon the period at which we ap-
ply our remedies, and inasmuch as experience has demonstrated that
all the forms of carcinoma are not equally curable; we should be the
more anxious to discover accurately the state of the morbid product,
and adopt in time a judicious and satisfactory remedial system.
Again, the knowledge of the species will determine the rapidity of
its development and its most probable result; which, when associated
with the time occupied in its primary development, will enable the
physician to prognosticate accurately the eventual termination.
It is evident from the above, that it is impossible to give a precise
definition of carcinoma; but the following, given by Mr. Carswell,
appears to approach as near the truth as is possible.
** Carcinoma consists in the formation or deposition of a peculiar substance,
which presents great variety of consistence, form, and colour; frequently as-
sumes a definite arrangement, and possesses a vascular organization of its own,'
gives rise to the gradual destruction or transformation of the tissues in which it
is situated; affects successively or simultaneously a greater or less number of
organs, or has a remarkable reproductive tendency."
Seat and origin of carcinoma, — In order that we may ascertain
Carswell on the Elementary Forms of Disease. 427
the manner in which carcinoma is formed, it is necessary that we
should examine it in its forming stage, before it has produced de-
struction of the texture in which it is deposited. Examined in this
way, it appears manifest to our author that it is either the production
of nutrition or of secretion. When it results from the nutritive efibrts
of the system it is eliminated from the blood, in the same manner
that any of the healthy constituents are separated, and thus enters
into the molecular structure of the organ. On the other hand, when
its deposition is eftected by secretion it is found upon the free sur-
faces, as are the natural secretions upon the serous surfaces: inde-
pendent of these locations, and as an inference from the manner in
which it is formed, we are authorized to state that the carcinomatous
constituent is also found in the blood: indeed, the observations of
Mr. C. warrant the presumption, that in the great majority of those
cases which terminate fatally from this disease, the foreign substance
is to be found after death blocking up some of the larger venous
trunks.
The liver and stomach will exemplify the mode in which carci-
noma is primarily deposited in the molecular structure of organs.
Thus, if we make a section of a liver containing round or irregular
masses of scirrhoma or cephaloma, we shall be able to determine the
mode by which they are developed: the first evidence of the disease
is a change of colour in one or more acinL The red or yellow colour
disappears, and is succeeded by a pale milk-like or straw colour,
with increase of their consistence.
During this change of colour, the form and bulk of the acini remain
unaltered: now, it is evident that the acini could not retain their ori-
ginal form and bulk if the foreign substance was deposited in the al-
ready existing structure; for if any additional substance is added to
the healthy acinus, the first manifestation of change would be the al-
teration of its form or increase in its bulk: but as this is not the case,
but on the contrary, the evidences primarily being an alteration in
colour and consistence of the acinus, we must infer that it is accom-
plished in a manner analogous to that in which the nutritive function
is carried on. If we continue the investigation, we discover this al-
teration extended to neighbouring acini, and arranging themselves
into groups of various sizes, from a millet-seed to a cherry, preserv-
ing at the same time the essential characteristics of the hepatic struc-
ture— the form, bulk, and arrangement of the acini; until ultimately
the bulk of the tumoursjncrease so as to resemble a uniform, larda-
ceous mass, or some other form of the carcinomatous deposition..
428 Carsvvell on the Elementary/ Forms of Disease,
The formation of carcinoma in the stomach is very similar to the
process pursued in its development in the liver. The muscular coats
and intermuscular cellular texture favour the examination in conse-
quence of their colour and fibrous arrangement: the first manifesta-
tion is the paleness of the mus.cular fibre and its increase in consist-
ence; here, as in the liver, the bulk is not altered in the least degree;
neither is there a change in its form and distribution. The intermus-
cular cellular tissue acquires a more firm and consistent character;
and as. the disease progresses the bulk becomes greater, the structure
of the organ assumes a fibriform arrangement, and becomes hard and
transparent, presenting us with the characteristics of scirrhus. At a
still more advanced stage of disease, the nutritive process of transfor-
mation is no longer distinguishable; the muscular and cellular tissues
being completely converted into a homogeneous mass; which is even-
tually softened down, or assumes the mammary, medullary, or hae-
matoid characters of carcinoma.
Our author conceives that the formation of carcinoma on serous
surfaces, corroborates in a striking manner the correctness of his
views in relation to its development; this mode of production he terms
secretion; and although the difference between it and that which we
have above called nutrition is merely nominal, yet we may contem-
plate it here as the result of the usual secreting process of the organ,
without the slightest alteration in its texture: it is therefore a most
conclusive evidence that an alteration in texture is not essential to
the development of this disease, but that it owes its origin to other
causes, and must be referred to some peculiar condition of the great
pabulum vitae*
Mr. Carswell remarks that the trite but important observation, that
hundreds of individuals are affected with inflammation, without this
local disease being followed by any other than its usual effects, places
in the clearest light the necessity of a previously existing modifica-
tion of the economy, as the immediate and essential condition of the
speciality of the heterologous formations when they occur in conjunc-
tion with inflammation. We illustrate this by the following case,
which is not an unfrequent occurrence. An individual has a scirrho-
matous or cephalomatous tumour on the external surface of the body.
He has an attack of pneumonia, of which he dies in the course of a
few days: on examining the lungs or pleura, instead of finding an ef-
fusion of serum, coagulable lymph, or pus — the usual results of in-
flammation—we discover that the lung is converted into a solid mass
resembling a section of fresh pork; in fact, it is in a scirrhus state.
Carswell on the Elementary Forms of Disease. 429
We cannot explain this upon the ground that the matter of the ex-
ternal tumour is absorbed, and thereby contaminated the blood, and
ultimately deposited in the lung structure; for admitting this to be
true, the difficulty is not yet solved, for how shall we explain the
production of the first tumour? Again, such depositions occur after
inflammation in individuals who have had no previous carcinomatous
tumour, we must therefore pass beyond the local disease, viewing it
merely as the expression of a condition of the system by which carci-
noma is produced, and from which the disease originates.
We have stated above, that the heterologous substance accumu-
lates in the blood, and now refer to it as an important fact, illus-
trating in a great degree the formation of carcinoma in the molecular
structure of organs, or on the free surfaces of serous membranes.
That this substance does accumulate in the blood, is apparent from
its presence in the vessels which ramify in carcinomatous tumours, or
in their immediate vicinity; from its being traced in the vessels of aa
organ in which this substance is found from their trunks to their ca-
pillary terminations; from its being detected in vessels having no
direct communication with an affected organ, as, for instance^
in a small portion of the vena portae; and lastly, from its presence
in the blood effused into the cellular tissue, and on the surface of
organs.
Carcinomatous substance has not been detected in the arteries, bat
always in the venous trunks and their capillary ramifications; the
contractility of the artery constantly urges on the circulating fluid,
and thereby prevents the accumulation of any substance within its
walls. The characters of carcinoma occurring in the veins, vary
considerably; it is either the lardaceous, the mammary, medullary,
or haematoid form, isolated into masses so conspicuous, that we can
readily distinguish one from the other; at another time it takes the
form of the vessel, and is merely in contact with it, and sometimes
we have it connected to the coats of the vessel by a thin layer of
colourless fibrine. From what has been said of the origin and sub-
sequent development of carcinoma, it is evident that it must be as-
cribed to a peculiar condition of the blood, from which the morbid
constituent is separated during the acts of nutrition or secretion, and
not to any state or condition of the texture or organ in which it is
formed; but we cannot omit a brief notice of the explanation of the
formation of this substance afforded by Dr. Hodgkin in the Medico-
Chirurgical Transactions, in which he labours to prove, that the pre-
sence of a serous membrane of a cyst-like character is essentially
430 Carsvvell on the Elementary Forms of Disease,
necessary for the production of carcinoma. To this view Mr. Cars-
well objects most decidedly, remarking, that he does not deny but
that the heterologous deposits are sometimes provided with serous
cysts, but that it is far from being the prevailing provision, and that
when it does occur, it is to be explained by the fact, that the deposit
is not on the free surface of the serous membrane, but in the sub-
serous cellular tissue, external to the cyst, and carrying the serous
surface before it; this view, he contends, is correct in all the instances
cited by Dr. Hodgkin. The existence of cysts is never observed in
the liver, coats of the stomach, lungs, kidneys, brain, lymphatic
glands, spleen, and blood, and whenever we find them in the ovaries,
testes, or mammae, they must be esteemed a mere coincidence, or as
a consequence of the disease, and not as a cause or necessary condi-
tion of it.
The physical characters of carcinoma are contemplated under the
form, bulk, colour, and consistence, which it assumes in the various
textures and organs of the animal body. The form of carcinoma
varies greatly, and is in some degree dependent upon the mode in
which it is deposited; when it is formed by the nutritive powers of
the organ, it presents us in its early stage the form of the healthy
structure of the organ; thus, in the acini of the liver we have the he-
terologous deposit subscribing accurately to the external contour of
the sound or healthy granule of the organ; in the stomach a similar
state of the carcinomatous formation takes place; the muscular, cel-
lular and mucous tissues of the organ determine the primary form.
But in the forming stage in the brain, lymphatic glands, and testes,
the original condition of the organ is not apparent, in consequence
of the heterologous mass assimilating in colour the healthy structure
of these organs. As the disease progresses, the form and arrange-
ment varies, and ultimately assumes one of these cx)nditions — the
tuberiform, stratiform, or ramiform. The tuberiform arrangement is
by far the most frequent condition of carcinoma. This arrangement
arises frequently in the interior of organs, from the uniform density
of the organ compelling the deposit to take the globular form; from
this cause v/e find that it is by far the most frequent occurrence in
the liver. On the secreting surfaces of serous membranes the glo-
bular is soon converted into the pyriform node, either in consequence
of its mode of attachment, or of less resistance being opposed to its
growth in one direction. When it is accumulated in separate por-
tions of the cellular tissue, and included within a capsule, it has a
lobulated appearance, and in the sub-mucous tissue it exhibits the
Carswell on the Elementary Forms of Disease. 431
cauliflower or mulberry form. The stratiform deposit is more fre-
quently found in the sub-serous cellular membrane, located in layers
of various size, and presenting no definite arrangement^ it is most
frequently found in their circular patches, from the size of a pin's
head to an inch in diameter. This form of carcinoma is seldom re-
cognised without the presence of disease in some important organ.
The third or ramiform arrangement of carcinomatous matter is de-
pendent upon its location in the veins; it is frequently discovered in
the emulgent vein and its ramifications, so that a section of the kid-
ney presents this matter escaping by pressure from the injured
vessels. It is also met with in the minute and larger venous
vessels of the stomach, in the vena portse, lacteals, and lymphatic
glands.
The quantity of the morbid product deposited either in the struc-
ture, or on the free surfaces of organs, varies greatly; but as a
general rule, we may say it is deposited with far more freedom upon
the free surface than in the structure of an organ. In the liver we
have it from the size of a millet-seed to an orange; in the lungs, tes-
tes, and mamma, in consequence of the yielding character of their
structure, it may accumulate to an immense size; while in the inter-
muscular and subcutaneous cellular membrane it is freely diffused
throughout its whole extent. Mr. Carswell remarks, that pressure
will retard the development of carcinoma, and if it were possible to
exert constant pressure, its increase might be restrained, and the
disease so circumscribed as to render it less liable to terminate fa-
tally; but it should also be borne in mind, that while pressure exerts
considerable influence upon its development, yet when it is after-
wards removed, the disease progresses with astonishing rapidity, and
speedily hurries its victim to the grave.
The colour of carcinoma is of great importance to the pathologist,
inasmuch as it is entirely different from that of any other of the
heterologous formations, and will therefore indicate with unerring
precision the presence of this deposit in any texture or organ; it is
most generally white, with a shade of gray or blue, sometimes it is
yellowish, or brown, or red, in consequence of the colour of the or-
gan in which it is situated, or from the presence of blood, bile, pus,
or some other accidental circumstance.
" But the principal modifications of colour of carcinoma are seen in the seve-
ral varieties of both species of the disease; these varieties, as I have already
stated, resembling more or less in colour that of the organ or tissue, whence
have been derived their respective appellations, as that of cartilage, of the pan-
432 Carswell oji the Elementary Forms of Disease,
creas, of fresh or boiled pork, of coagulated albumen or fibrine, of the mam-
mary glands, of the cerebral substance, or a mixture of the latter and blood."
It is evident that our author considers the varieties of carcinoma
to be dependent upon the state or structure of the organ in which
they repose, and not upon any essential or specific difference in the
matter deposited, for one of his fundamental positions appears to be,
that the blood must first undergo a change in its condition, and con-
tain the essential principle of this morbid mass; during the process
of nutrition and secretion, it gives up this principle, which, from its
contiguity to highly vascular textures, becomes the recipient of arte-
rial ramifications from the adjacent vessels, and ultimately presents
us a more or less perfect organization; if, on the other hand, its de-
position is effected in a less vascular or imperfectly organized tissue,
it manifests less disposition to become organized.
The consistence of this substance has been esteemed one of its most
important physical characteristics; when it is of greater consistence
or firmness than the organ in which it is embedded, it has been termed
scirrhus, and regarded as in its incipient or forming state, and on the
contrary when it has less firmness, it is said to be the result of the
softening process; that is, it has advanced another stage in the pro-
gress of the disease; these views are shown by our author to be er-
roneous, since the carcinomatous matter may in its first stage be either
"as hard as cartilage, soft as brain, or fluid as cream." The con-
sistence depends on the nature of the organ in which it is deposited;
the elementary composition of the deposit, and the changes which
take place either in the deposit itself or in the tissue with which it is
in contact. Accurate investigations of the chemical characters of
carcinoma are not easily obtained, in consequence of the difficulty of
insulating the matter from the texture of the organ around it; but that
furnished by Lobstein in his "Traite d'Anatomie Pathologique" is as-
sumed by our author as the most correct; from which it appears that
in seventy-two grains of scirrhous breast were found — albumen, two
grains; gelatine, twenty; fibrine, twenty; fluid fatty matter, ten; water,
twenty grains: nearly the proportion of the above elements were found
in seventy grains of scirrhous uterus. It is just to observe that the
chemical composition of cephaloma is not uniform in all its stages;
thus in its crude state it contained a greater quantity of gelatine than
albumen; while in its stage of softening it contains a greater quantity
of albumen than gelatine. A carcinomatous tumour anatomically ex-
amined presents four elements; carcinomatous matter, cellular,
fibrous and serous tissues, and blood-vessels. The carcinomatous
Carswell on the Elementary Forms of Disease. 433
matter constitutes by far the greatest bulk of the tumour, and is
either uniform, granular, radiated or lobular in its arrangement. The
cellular tissue is mostly small in quantity, and intersects the tumour
in various directions, encloses the matteij, separates it into granules,
bundles or lobules, and serves to conduct blood-vessels for its nutri-
tion and growth. The fibrous tissue does not often enter into the for-
Tnation of carcinoma as we are now considering it. The serous tissue,
on the contrary, is frequently present, forming either a capsule to de-
posit, or giving rise to cysts containing gelatinous, albuminous or
other fluids. The blood-vessels vary in size, and are frequently very
numerous; their walls are extremely delicate; and have much more
of a venous than arterial character. They are, as we have above re-
marked, derived from those of the surrounding tissue; they assume
the appearance of striee or slender streaks of blood, and afterwards
acquire a cylindrical arrangement and ramiform distribution, consti-
tuting what is termed the proper circulation of cephaloma. The
blood-vessels in scirrhoma seem to be the unaltered vessels of the
surroundina: tissue enclosed within the substance of the morbid mass.
In contemplating the physiological characters of carcinoma, the func-
tions of circulation and nutrition actively carried on in these deposits
are of the first importance: by turning our attention to the direct or
collateral circulation, we have an explanation of the remarkable
changes which take place during the progress of these formations.
The quantity of blood and the various shades of colour of the carci-
noma will depend upon the freedom with which the circulation is per-
formed. Obstruction to the returning circulation would produce con-
gestion of the whole or a portion of the tumour, giving rise to an in-
crease in colour, or a rupture of the vessels, with effusion of blood in
clots, producing afterwards the cerebriform character of carcinoma;
if the obstruction is perfect the circulation in the tumour ceases, and
death ensues in all its parts which have been supplied with blood by
the now obstructed vessels.
** The termination of carcinoma in mortification from obliteration of the veins
is far from being* a rare occurrence. It sometimes occurs in whole tumours,
but is most frequently observed in portions of them, or in some of the small tu-
mours of which larger ones are frequently composed, that are attached by narrow,
pedunculated extremities. The unequal development of one of these small tu-
mours may g^ive rise to compression of a neighbouring one; or the tissue to
■which they are attached may, from its unyielding nature, act as a ligature on
their pedunculated extremities, and intercept the return of the venous blood
through them. The protruding portion, now relieved from the pressure to
which it was before subjected, increases rapidly in bulk; but the dimensions of
the opening through which it passed remaining the same, a degree of constric-
No. XXVIIL—August, 1834. 2>7
/
434 Cars well on the Elementary Forms of Disease,
tion is produced which arrests the circulation through its vessels, when it dies
and sloughs. Hence the delusive hope that nature had effected a cure of the
disease, not only on account of the diminution of bulk, but also the imperfect
cicatrization which sometimes follows the sloughing process. It is on the prin-
ciple of diminishing the supply of blood for the nutrition and growth of these
tumours, that the frequent local abstraction of this fluid, the application of cold,
the use of the ligature and compression, have been recommended as the most
effectual means of retarding or arresting their progress."
Congestion, haemorrhage, softening and sloughing take place in
both species of carcinoma: in scirrhoma, they originate in the vascular
system of the tissue included within the carcinomatous mass, and
are not less destructive than those which arise in the proper and col-
lateral circulation in cephaloma. Nerves as a new production have
never been discovered in carcinoma, although M. Maunoir, of Geneva,
asserted that cephaloma from its resemblance to the brain was in re-
ality the substance of the nerves effused under the influence of some
peculiar morbid state.
We have thus far given an accurate and faithful analysis of what
we consider to be the commencement of one of the richest contribu-
tions to pathology in the present day; and which must eventually com-
mand a high and elevated rank as authority upon the subjellte treat-
ed of in its pages. While the text Ijears upon it the impress of a
sound and philosophical mind, its illustrations indicate a chaste and
discriminating taste. A. L. W.
( 435 )
BIBLIOGRAPHICAL NOTICES.
XIV. Observations on Injuries and Diseases of the Rectum. By Herbert Mayo,
F. R. S. Surgeon to the Middlesex Hospital. London, 1833. pp. 220. oct.
Diseases of the anus and rectum are sources of great distress to a no small por-
tion of the human family in every quarter of the globe; some of them are among
the most painful, and others among the most disgusting affections which fall
under the notice of the surgeon, and he who contributes in the slightest degree
to elucidate their nature and treatment, deserves the cordial thanks of the pro-
fession and the public. The authors who have written upon these complaints
are indeed sufficiently numerous to furnish no inconsiderable catalogue; yet it is
to be regretted that the diagnosis of the various morbid changes which occur
at the outlet of the alimentary canal, is still involved in great confusion. Under
each of the several heads of neuralgia, fistula, piles, scirrhus. Sec. we frequent-
ly find diseases enumerated which have no resemblance in their causes, nature,
or location, until it has become almost necessary for an author, who wishes to
be definite, to explain his own acceptation of terms familiarly employed by all:
even the anatomy of the parts interested is not sufficiently borne in mind by
most of the writers who treat upon their chirurgical treatment. Lest we should
be deemed harsh or hasty in these strictures, when it is remembered that men
of high merit and universal reputation are among the censured, we will men-
tion one or two facts in explanation of our meaning. Under the heads of haemor-
rhoids, we find included by different teachers of eminence, all the following
affections:— varicosity of the hsemorrhoidal veins, ecchymoses about the anus,
dense and firm tumours of little vascularity, partial evertions of the integuments
of the anal canal, hypertrophy of the mucous membrane, various excrescences
exterior to the anus, condylomata, (which are even described by some as fleshy
tumours,) and probably some other enlargements, for we cannot pause to com-
plete the list! When a surgeon, then, speaks of a case of piles, who shall com-
prehend to which of these heterogeneous affections he alludes? As to the
vagueness in using anatomical terms, we will merely refer to the almost con-
stant habit of speaking of the sphincter muscles in t^e singular number, as
though there existed but one sphincter; a habit well calculated to confuse the
student in his practical inferences, as will be perceived hereafter.
The little work before us is by no means free from the defects just mention-
ed, but it is written, upon the whole, with considerable perspicuity, and al-
though it may not add very largely to the stock of knowledge already possess-
ed by the profession, it contains many valuable facts and suggestions, marked
by a due degree of originality.
The first chapter of Mr. Mayo's work treats of lacerations of the rectum whether
partial or complete. To the former species of laceration he applies the term
fissure of the mucous membrane. It is a transverse rent in the internal membrane
caused by the action of indurated faeces in persons habitually costive, and is lo-
436 Bibliographical Notices.
csited just within tJie spkinder, (i. e. the internal sphincter.) This accident must
not be confused with the Jissure of the anus of Boyer, which is generally seated
just within the external sphincter, and is always longitudinal, for these affections
are very widely different both in symptoms and treatment. Exquisite soreness is
generally felt at the n\oment of the accident, and is renewed, with increasing se-
verity, at each succeeding stool. The rent soon degenerates into an ulcer, and
is readily recognised by the finger. It is surrounded by slight hardness, and is
almost always found at the back part of the canal. The mode in which this la-
ceration is produced must be obvious to all who are acquainted with the ana-
tomy of the part. It is at first very simple in its nature, and yields readily to
the daily use of enemata of warm water, the application of mild mercurial oint-
ment, and proper laxatives; but, when neglected, it may produce a long train
of deceptive symptoms, and may become exceedingly unmanageable, yielding
only after the division of the sphincter, as performed in the operation for fistula
in ano. Several very interesting cases are given, and the third case deserves
especial attention, because its nature was at first mistaken.
The patient had been labouring under a train of anal symptoms for fifteen
months previous to his application to Mr. Mayo; and the rent appears to have
taken place but one month after their first commencement. The symptoms
were briefly as follows: — heat and pain at stool, continuing some hours, follow-
ed by numbness; during the pain the anus was strongly drawn upward. The
pain was extended to the hips and sacrum. A slight mucous discharge follow-
ed the laceration. Other symptoms led to a suspicion that the prostate gland
was affected. The patient urinated frequently, pain deeply seated in the peri-
neum followed the discharge, and mucous flowed from the urethra. The pios-
tate gland was large, and tender on pressure. The patient was treated by the
hip-bath, leeches to the perineum, and cups to the sacrum, opiate supposito-
ries, and tepid enemata. The bowels became regular, but the other symptoms
were unabated. At last the ulcer was detected, and as it did not yield to the
usual measures of Mr. Mayo, the sphincter was divided, and the incision pre-
vented from healing immediately by means of lint. Prompt relief was expe-
rienced, and under the application of mild mercurial ointment, the ulcer was
cured. The affection of the urinary apparatus subsided, pari-passu, with the
rectal disease.
This case is highly interesting, as an elucidation of the strong association be-
tween the urinary apparatus and the anus, and also from the resemblance be-
tween the symptoms described and those of the first stage of the neuralgia of
the anus of M. Campaignic, or the tic douloureux of the bladder, as it is term-
ed by many surgeons, with at least equal propriety. Indeed, it may be laid
down as a safe and valuable practical precept, that when there is a difficulty in
assigning an obvious cause for any unusual train of symptoms in the bladder or
urethra, the anus and rectum should be carefully examined, and vice versa.
Next in order follows a case of recto-vaginal communication from complete
laceration of the intestine; then another, of stercoraceous abscess from the same
cause, in which there is nothing novel; both accidents occurring from costive-
ness. Mr. Mayo then gives some terrible instances of laceration from the use of
syringes; among the rest he refers to a preparation in St. Bartholomew's Hos-
pital from the body of a patient killed by the injection of a pint of water-gruel
Mayo on Injuries and Diseases of the Rectum. 437
into the cavity of the ahdomen! — and he states that a similar accident has oc-
curred in private practice! Indeed, it is wonderful that more numerous disas-
ters of this kind are not forced upon the notice of the public, when every igno-
rant nurse, and even patients themselves, are encouraged to thrust three or
four inches of an inflexible metallic tube into a tortuous canal, of which they
understand not the course, and when it is well known that if it is introduced in
the usual direction, it comes to bear directly on the prostate gland, long before it
has entered to that extent! No syringe, placed in unprofessional hands, should
be furnished with more than two inches of pipe — Mr. Mayo says one inch and
a half. The neglect of this precaution is believed to be one of the principal
causes of the alarming frequency of diseases of the anus on the continent of Eu-
rope, and especially in France.
Our author next proceeds to speak of the lacerations occurring during la-
bour, the horrible character of which, when they prove extensive, are well
known to all as amongst the most distressing that can occur to a surgeon; for-
tunate indeed it is, that they are rare! Mr. Mayo has been repeatedly success-
ful in closing extensive rents involving the sphincters, by relieving the tension
of the sides of the opening, caused by the retraction of those muscles, by means
of lateral incisions, such as are made in the operation for fistula. The muscles
being thus divided on each side, the edges of the rent, if recent, are repeated-
ly stimulated by nitrate of silver, and if long neglected, are pared off and drawn
together by sutures. After the rent is healed, the lateral incisions are allowed
to heal, and the sphincters recover their power.
The second chapter treats o^ protrusion of the redum. It contains a very fair
cursory view of the affection, but we observe nothing of novel interest, and
must therefore confine ourselves to a very few remarks. We must protest
against the grounds upon which Mr. Mayo opposes the opinion attributed to
Dupuytren, that prolapsus ani is a displacement of the mucous and submucous
tissue only. This opinion is decidedly that of the mass of tlie profession, and
our author opposes to it, firstly, a figure from a preparation in the museum of
King's College, in which an inversion of all the coats of the intestine is present-
ed, but without any history of tlie circumstance; and secondly, a case of his
own, in which, after removing the lower end of the rectum, together with the
sphincters, prolapsus of the whole intestine supervened. Upon such evidence
he appears to draw the conclusion, that prolapsus ani is invariably an inversion
of all the coats! No doubt the whole thickness of the intestine is sometimes in-
volved, though we have always been inclined to doubt the possibility of such
an occurrence in proper prolapsus ani, being disposed to attribute the com-
plete eversion to the gradual descent of a true intussusception of tii^ rectum
occurring originally at the superior margin of the internal sphincter, or at the
upper part of the sac of the rectum — both which accidents we have examined
particularly, but we cannot pause to argue the point at present. Mr. Mayo ob-
jects to M. Dupuytren's mode of operating for the cure of confirmed prolapsus,
by removing several folds of the integument around the anus; he recommends
the excision of a single fold, (p. 43;) but certainly the number of folds removed
should bear some relation to the mass of relaxed skin, which is often exceed-
ingly redundant, and by its constant pressure dilates and weakens the sphinc=
ters, especially the sphincter externus.
43S Bibliographical Notices.
The third chapter treats of hsemorrhage from^ and pain in the rectum. In
speakhig of the nervous affections which not unfrequently deceive the practi-
tioner, in cases of haemorrhage from the rectum, the author refers to the very
interesting- case of a lady mentioned by Mr. Brodie in the Medical Gazette, Vol.
V. where the disease was mistaken for stricture of the oesophagus. We recent-
ly heard from Dr. Samuel Jackson, of a most singular instance of hsemorrhoidal
flux simulating disease of the heart, and at first treated as such. Whenever a fe-
male presents that peculiar aspect that marks the habitual and excessive loss of
blood, accompanied by severe palpitations of the heart, or inexplicable nervous
disorder of any kind, we should always assure ourselves as to the existence of
haemorrhage from the rectum as well as from the uterus.
In chapter fourth Mr. Mayo considers the nature and treatment of piles. As
our limits will not permit us to analyze its contents, we dismiss it with the re-
mark, that the second section, on external pilesy is liable to the censure passed
at the commencement of this article; it confuses, under one general head, se-
veral very distinct affections. At page 99, the author judiciously remarks, that "as
a general rule, growths external to the anus are to be removed by the scalpel,
as the tumours which form within, are, for the most part, best removed by the
ligature," we cannot forbear alluding in this place to the beautiful method of
operating adopted by Dr. Physick in cases of tumour partly within and partly
external to the verge of the anus. He employs the ligature, but in order to
prevent the terrible and dangerous agony resulting from the action of the liga-
ture upon the exquisitely sensitive integument about the margin, he divides the
integument round the external portion of the tumour, and carries the ligature
through the route of the incision so as not to act upon any portion of skin,
while he enjoys every security against dangerous loss of blood.
In the succeeding chapter, on Jistula in ano, we are struck with the light
manner in which the danger of haemorrhage after operations is treated.
** It sometimes happens, if the sinus extends some length by the side of the
rectum, that a slight haemorrhage follows the operation. This, however, is
seldom more than bathing the part with cold water, and keeping it exposed,
will arrest. I have never seen it extend beyond this. Still it is evident that smart
arterial haemorrhage may sometimes take place from the rectum, cither after
operations for fistula, or on other occasions." p. 118.
The author objects to the operation by ligature as unnecessarily tedious. We
are not among those who live very strongly in dread of haemorrhage from ordi-
nary incisions about the rectum, being fully convinced that although it is often
alarming in extent, and at other times concealed and insidious, yet it is con-
trollable in most cases when the surgeon is both vigilant and thoroughly com-
petent; but he who would undertake to lay open by the knife the whole extent
of some fistulae that are met with in the course of a tolerably extensive prac-
tice, would certainly find to his cost that there are vessels in the rectum, that
cannot be checked by cold and exposure, or even by the needle and ligature,
with all the aid of Weiss's improved speculum ani, yet these fistulsc yield rea*
dily to those means against which Mr. Mayo objects.
The remainder of the work is defective in arrangement, but it is replete
with valuable matter. Twenty-three pages are devoted to a subject of great
importance, but one whiph, perhaps, may be said never to have received a phi*
Mayo on Injuries and Diseases of the Rectum. 439
losophical investigation; — the remote and immediate causes of costiveness. The
theme is one that would require much more space than the entire volume oc-
cupies, in order to its full discussion, but short as are these remarks, they pos-
sess great interest, and are quite sufficient to expose the fallacy of the common
custom of forcing or attempting to force the peristaltic action in all cases alike
by means of purgatives. Next follow some remarks on the introduction of in-
struments into the rectum — rendered doubly valuable in consequence of the
freedom with which some practitioners have of late recommended the dilatation
of strictures in the sigmoid flexure of the colon, &c. operations that have been
recommended with far too little caution, and which require consummate dex-
terity, the most accurate tact, and a profound knowledge of the anatomy of the
parts, to render them even tolerably safe. According to Mr. Mayo, a good wax
rectum bougie should be perfectly flexible when dipped in warm water. Even
when perfectly flexible it meets with resistance after entering five or six inches,
from its catching in the sacculi of the intestine, which it is impossible to avoid,
and which it pushes before it like so many blind sacs. If force is used, the bou-
gie tears the gut and enters the belly. Some nicety is required to distinguish
this resistance from stricture, and surgeons are occasionally deceived. By gent-
ly withdrawing the instrument, changing its direction, and then again advanc-
ing it, the proper canal may be followed; Mr. Mayo makes no exception to this
rule, but there is a preparation of a healthy rectum in the cabinet of Dr. Horner,
Professor of Anatomy in the University of Pennsylvania, which we presume could
not possibly have given passage to a bougie. An instrument from half to three-
quarters of an inch in diameter is considered quite large enough, and if it passes
readily without pain it may be safely presumed that there is no contraction.
Before the introduction a double bend should be given to it — one to adapt it to
the curve of the sacrum, the other to meet the inclination of the sigmoid flex-
ure to the left, but as this flexure in some rare cases inclines to the right, the
surgeon must be awake to any unusual resistance, and take his measures ac-
cordingly. Fortunately, it is seldom necessary to introduce the bougie beyond
four or five inches — though Mr. Mayo once passed it three feet into the canal!
The introduction of flexible tubes requires still greater care, because they are
more liable to become entangled.
** The great point which cannot be too strongly impressed on the mind of
the practitioner, is the extreme delicacy of the part, and the readiness with
which it will tear under very moderate pressure."
The subject of strictures of the rectum, both spasmodic and permanent, is
treated at some length; much stress is laid on the proper regulation of diet as a
means of counteracting the former, and many practical hints are given for the
management of the bougie in the latter. Numerous highly interesting cases are
narrated, and in several of them the permanent stricture was divided. This ope-
ration, however, the author does not recommend except under very pressing
circumstances, because of the danger of concealed hsemorrhage into the rec-
tum, which sometimes goes on to an alarming extent, (p. 174.) Cases are
also given of strictures of the sigmoid flexure, and other parts of the colon, and
of obstructions from invagination of the superior within the inferior portion of
tlie rectum, as described by Mr. Earle and Mr, Chevalier. Then follows a very
440 Bibliographical Notices.
short notice of spasmodic and permanent contraction of the anus, the former of
which he considers as *' a kind of cramp."
The seventh, and last chapter, treats of cancer of the rectum in its two dis-
tinct forms, the one attended with firm, cartilaginous thickening" of the muscu-
lar coat, with abrasion of the mucous coat, the other producing a fungoid
growth, and attended with much greater thickening. The various means of
lessening the evils inseparable from these incurable affections, and of prolong-
ing life by regimen, the bougie, incisions, &c. are described.
We have then an account of the excision of a carcinomatous tumour within
the rectum, by Mr.Crosse of Norwich, terminating ultimately in a return of the
disease, and death: and a case in which Mr. Mayo removed the lower portion
of the intestine, together with the sphincters, for a similar complaint. The pa-
tient enjoyed considerable comfort after the operation. The cicatrix formed a
canal which neither embarrassed the discharge of faeces materially, nor permit-
ted their involuntarily flux. Irremediable prolapsus supervened, and the pa-
tient died of abdominal inflammation about two years after the operation. The
work concludes with another case of carcinoma terminating fatally after the
partial removal of the diseased mass by ligature.
This treatise certainly contains much valuable matter; it is written in a lucid
style, though it bears marks of haste, which are perhaps a sufficient explanation
of its imperfect arrangement. The strongest censure which we pass upon it is
a rare one in these latter times — it is too short; had it pleased the author to be-
stow upon the subject a little more time and space, the work would have been
more worthy of the powers and practical information of the writer, and of the
importance of the subject; and yet, perhaps, it is ungrateful to complain while
we acknowledge that the obligation conferred is by no means inconsiderable.
R. C.
XV. An Investigation into the Remarkable Medicinal Effects resulting from the
External Application of Veratria. By Alexander Turnbuli, M. D. London,
1834. pp. 96.
Almost all the plants belonging to the natural order Colchldeas are possessed
of energetic medicinal properties; this is owing to a peculiar principle common
to them all — discovered by Pelletier and Caventou, and which has received the
various names of veratrinum, veratrina, veratria and sabadilline. In a late memoir
by Mr. Couerbe, it appears, however, that this substance is not a simple body,
but is composed of three separate principles, which he terms, veratrine, saba-
dillinCj and mono-hydrate of sabadilline.
The veratria of commerce is in the form of a fine white powder, without
smell, but acting as a violent sternutatory. Its taste is acrid, and when intro-
duced into the stomach, even in minute doses, acts as a powerful emetic and pur-
gative. When applied externally, in the form of ointment, however, a very
different series of actions are produced—" when rubbed upon the surface of the
body to the extent of six or eight grains a day, for several weeks or even
months together, it calms irritation, removes pain, and produces considerable
elevation of spirits." Dr. Turnbull also states that such a degree of constipa-
tion is often induced as to require the use of purgatives. In diseases, attended
Turnbull on the External Application of Veratria, 441
with aqueous effusion, the external application of veratria is attended with the
happiest effects, as it acts as a powerful diuretic, which it never does in other
cases.
Dr. Turnbull goes on to say, that the ointment causes no outward marks of
irritation on the skin, even when the friction has been continued for some length,
of time; in some rare instances a slight blush is produced which soon vanishes.
After some grains have been rubbed in, however, there is a sense of tingling
and warmth in the part, and until this is produced, the peculiar effects of the
medicine do not manifest themselves. After the ointment has been used until
the general system is under its influence, the feeling of heat and tingling ex-
tends itself over the whole surface of the body, sometimes accompanied with
involuntary twitchings of the muscles of the mouth and eyelids, but these lat-
ter symptoms disappear if the use of the ointment be discontinued for a day
or two.
Dr. Turnbull has found that where veratria was applied to a part denuded of
the cuticle, although the effects on the system were much greater than when
applied to an unbroken surface, yet, that the extreme irritation which ensued
forbade a repetition of the practice.
After having thus given an account of the general effects of the medicine,
the author next proceeds to the consideration of the diseases in which he has
found it useful. The first of which he speaks are offcdions of the heart in which
although there is no decided organic derangement, the symptoms are of suck
a character as to be exceedingly distressing, as difficulty of breathing, with
cough and expectoration, inability to remain any length of time in a recumbent
posture, palpitation, &c. &c.
In these cases he recommends the ointment to be made with fifteen to twenty
grains of veratria to the ounce of lard, and of this, a piece the size of a nut to be
rubbed over the region of the heart for five minutes, once a day. During its ac»
tion upon the system, the pulse increases in strength and regularity, and the dis-
tress and anxiety gradually wear away. Sometimes, however, the first or second
application of the remedy induces a great increase of the palpitation, but when
this irritation subsides, all traces of disease disappear with it.
Dr. Turnbull exemplifies its use in these anomalous disorders, by a variety of
cases, which are extremely interesting and fully confirm his statements of the
efficacy of the remedy. The next class of disorders in which he has found
veratria useful are the neuralgic affections, and he states that in these the re-
lief afforded is speedy and almost certain, and that in tic douloureux the par-
oxysm has been brought to a termination by the first friction, and never return-
ed. In most cases the ointment of the strength above-mentioned has been found
sufficient, but in some cases it has been requisite to use it of greater power,
even as high as forty grains to the ounce of lard.
In rheumatism Dr. Turnbull has used it in the acute stage of the disease with
decided benefit after the usual antiphlogistic remedies had been resorted to.
From the extent of surface affected in this disease, and the quantity of ointment
required to be used, the proportion of veratria should not be as great as in the
cases last mentioned, but should bear a certain relation to the space over which
\t is applied.
In paralysis he has not been enabled to try the effects of this remedy in suf-
442 Bibliographical Notices.
iici^nt number of cases to lay down any general rules for its employment, but
in those in which he did use it, he was well satisfied with its effects.
In dropsies he speaks of its successful employment in the highest terms, es-
pecially in hydrothorax, ascites and anasarca; many cases of which he states
were cured in a week or two, even where the severity of the symptoms was such
as to threaten the life of the patient in a few hours. There appear, says he, to
be two states of the disease in which the veratria is useful. One, where the
pathological condition of the organs on which it depended has been removed;
yet, where the aqueous effusion remains from a want of action in the absorb-
ents; the other, where the organic change is such as will admit of no remedy.
In the former, the use of the veratria soon restores the patient to health, and in
the latter, great relief is afforded. It is necessary to obtain the full benefit of
the remedy in dropsy, that preliminary measures may be adopted to put the
constitution of the patient in as good a state as possible before it is made use of.
In addition to these diseases. Dr. TurnbuU has derived much benefit from the
use of veratria in gout, amaurosis, &c. He concludes by stating, that it is of
primary importance, that the veratria be in a state of purity, or the practitioner
will be disappointed in the expected results, and adds that much found in com-
merce is adulterated with phosphate of lime.
We are afraid that Dr. Turnbull, like most other advocates of new remedies,
has viewed this article in too favourable a light, and that a more extended use
of it will show that it is not as infallible as his book would lead us to believe.
At the same time it richly deserves a trial, and we hope the results may be as
successful as those of the author of the memoir. R. E. G.
XVI. Transactions of the Medical Society of the State of New York. Vol. 11.
Part I. To be continued annually. Albany, 1834. 8vo. pp. 176.
The printed transactions of the various medical associations of Europe, rank
among the most interesting and useful of the works which compose the library
of the practical physician. Among the essays they contain are to be found the
original sketches, or more properly the nuclei of many of those valuable mono-
graphs in the various departments of our science, for which the profession is
indebted to the industry and talents of some of its most distinguished members.
In this country but few of our medical institutions are in the habit of publish-
ing their own transactions: the members preferring, in general, to present
their respective communications to the public through the medium of some one
of the medical journals published amongst us. The latter practice is in many
points of view, we are persuaded, to be preferred. However more imposing
a volume of medical transactions may seem, yet, from the long intervals at which
such works ordinarily appear, the very great expense attending their publica-
tion, and their consequent contracted circulation, it is evident that the interests
of all the members of the medical profession, as well they who communicate
as they who seek for information, are far better served by inserting the trans-
actions of medical societies in the professional journals already established, than
hy publishing them as separate works. In relation to this as well as to all other
subjects of a ^pientif^c nature, utility should be preferred to every other consi-
deration,
Transactions of the Medical Society of New York. 443
Notwithstanding" but few volumes of American medical transactions have ap-
peared, these few will bear a very favourable comparison with the printed
transactions of the most celebrated of the medical institutions of Europe. In
evidence of this statement, we might adduce, in particular, the transactions of
the state medical society of New York, the contents of the initial part of the
second volume of which we are now about to notice. It contains eight articles
on different subjects, no one of which can be read by the physician without
interest, nor without his deriving from it some important practical hint.
Art. T. Annual Mdress on Dysentery. By Thomas Spencer, M. D. — In this essay
we have an excellent, though concise account of the symptoms and causes of
dysentery, (in the course of which the writer presents some judicious remarks
upon the nature of epidemics generally) a very correct view of the pathology
of the disease, and an able outline of its proper treatment.
Dr. S'pencer ranks blood-letting, both general and topical, among the most
important remedies in the ordinary cases of dysentery. Its neglect in the early
stages of the attack has in very many instances, we are persuaded, subjected
the patient to a very great amount of unnecessary suffering, and not unfrequent-
]y to such neglect is to be attributed mainly the fatal termination of the disease.
Dr. S. very properly objects to the usual plan of irritating the diseased bowels
by repeated doses of active purgatives; preferring to abate the morbid irritabi-
lity and increased action of the intestines bythe judicious employment of opiates.
Dr. S. speaks strongly in favour of emetics in the treatment of dysentery. In
the very onset of the disease, when the stomach is free from any very decided
irritation, we have derived from their administration the most decided good ef-
fects; but at a later period we doubt very much the propriety of resorting to
their use.
Art. II. Medical Topographical Report of the County of Columbia, drawn up
hy a Committee of the Medical Society of that County.
Art. III. Medical Topographical Report of the County of Madison. By Alvin
Foord, M. D.
Both of these are useful and interesting papers. Our physicians generally
are beginning to appreciate the importance of similar reports, and we trust that
the time is not far distant when we shall be presented with them from every
section of the United States. Such reports when accurately drawn up afford
materials for a medical geography of the country, and are calculated to shed
not a little light upon the causes of endemic, if not of epidemic diseases generally.
Art. IV. Observations on the Use of Cold Applications in Local Inflammation.
By Dr. Cam,pble Waldo.
The remarks of the author are confined principally to the importance of cold
applications in wounds of the large joints, as an efficacious means of prevent-
ing the occurrence of inflammation, as well as of reducing it when present. The
correctness of the views advanced by Dr. Campble are supported by general
experience. So simple and at the same time so powerful a remedy is cold,
whether applied in the form of cold water or of ice, in preventing and reducing
inflammation, that in a large class of injuries, and of external and internal dis-
eases, it may with great propriety be ranked, upon the list of antiphlogistics,
immediately after general and topical blood-letting.
Art. V. On the Use of Opium in Bowel Affections. By C. King, M. D.— In the
444 Bibliographical Notices,
present paper Dr. King confines his remarks almost exclusively to the use of
opium in the treatment of colic. He commences by pointing out the folly of
attempting the cure of this disease by a course of purgation. Consisting as it
does, essentially, in an irritation of the mucous membrane of the large intestine,
which in the more violent grades of the disease is liable to run rapidly into the
most acute inflammation, and to terminate in gangrene, unless promptly arrested
by appropriate remedies, it is evident that purgatives can have no other effect
than to increase the irritation which constitutes the disease, and to accelerate
its fatal termination.
•* In almost thirty years practice of medicine," the Doctor observes, ** I never
saw a case of colic in which I could trace constipation of the bowels to be the
exciting or proximate cause. With me, then, there is no reason why cathartics
should cure colic, on any other principle than that of depletion. The difficulties
which accrue from the exhibition of cathartics in this complaint are often insur-
mountable and flital to the patient. These considerations have induced me to
abandon the use of cathartics in colic, and to restore this conclusion — that the
first stage is the time for the physician to act. In this stage the indication of
cure are, to remove the spasm and morbid sensibiUty from the intestines. To
answer these indications, the warm bath, semicupium, fomentations of the ab-
domen, and injections, are useful, and ought not to be omitted. But when the
attack is severe, the spasm violent, and the sensibility great, relief is only to be
obtained on general principles. These are blood-letting and opium. Bleed as
copiously as you would in pleurisy, and then give opium in as large doses as
you would in epilepsy ( ?) and repeat the exhibition once an hour, till the patient
becomes entirely free from pain, and falls asleep."
The practice here recommended is by no means a new one, or one peculiar
to Dr. King. Twenty-three years ago we were taught by our medical preceptor
in all violent cases of colic to bleed copiously, immerse the patient in a warm
bath, and then putting him to bed, to administer a large dose of opium.
Ever since we have been engaged in practice we have pursued the same plan
of treatment, and have seldom been disappointed in its results.
Art. VI. On the Utility of Iodine in Cases of Ununited Fractures. By Westel
"Willouby, M. D. — In this paper a single case is related, in which after various
means had been unsuccessfully employed to produce the union of a fracture in
the bones of the leg, lotions to the fractured limb were resorted to, composed
of a mixture of two parts of lime water, and one of the tincture of iodine. This
lotion was repeated twice a day, using at the same time considerable friction.
Within eight weeks from the commencement of the use of the iodine the union
of the fracture was complete.
Art. VII. Documents and Papers Explanatory of the Progress of CholerOy in
the Jiuburn and Sing Sing State Prisons^ during 1832. — This article contains
many interesting facts in relation to the disease of which it treats, but nothing
peculiarly striking or novel.
Art. VIII. ^n Essay on the History, Causes, and Treatment of Typhus Fever,-
to which the Annual Prize for the year 1828 was awarded. By Alfred Y. Magill,
M. D. of Winchester, Virginia. — This is the longest article in the present number
of the transactions, occupying about eighty-two pages. The essay confers a
very great deal of credit upon its author. Although had we sufficient space to
enter properly into a review of it, we should be inclined to dissent entirely from
the opinions of the writer in relation to the correct pathology of typhus fever,
Belden's Account of Jane Rider, the Somnambulist. 445
and would be obliged to deny the correctness of a few at least of his di-
rections for its treatment; we should, nevertheless, be constrained, viewing- the
essay as a whole, to bestow upon it our warmest approbation. Although the
author has not in our opinion arrived at a correct view of the organic lesions by
which the phenomena of typhus fever is produced, nor laid down in all its
details the proper treatment for their removal, he has the good sense to perceive
the folly, and reject the ridiculous notion almost universally prevalent a few
years since, that the disease, namely, is one essentially of debility, demanding for
its cure the liberal use of the most active and diffusible stimulants, and forbidding
the employment of every species of direct depletion; a notion that has produced
almost as great a destruction of human life as the disease itself.
Dr. Magill on the contrary has endeavoured to show, from the various circum-
stances and phenomena incident to typhus fever, that so far from being a dis-
ease of debility, it is essentially one of excitement, and frequently of inflamma-
tion and its consequences. He has further pointed out the fact, that the
autopsical examination of subjects who have died of the disease, satisfactorily
prove death in this variety of fever to be in general, if not always the result of
inflammation, disorganizing some important part of the animal machine.
The remedies Dr. M. insists upon, for the cure of typhtis, are blood-letting
early and judiciously employed; active purging; the aftusion of cold water upon
the skin; blistering and the other items of the antiphlogistic treatment. Bark
and wine he considers to be but seldom indicated. *' The majority of cases of
typhus," he remarks, " when treated properly in the primary stages, will not
often require the use of stimulants in the last." A proposition, the truth of
which we can affirm from the result of very considerable experience.
We shall not stop to notice the several points in relation to which we differ
in opinion from Dr. M. In discussing the subject of typhus fever it is all im-
portant to define accurately the precise concourse of symptoms to which the
term is intended to be restricted. By neglecting to do this, Dr. M. has, we ap-
prehend, in common with the majority of medical writers been led into the
error of grouping together the pathological signs of morbid conditions of various
internal organs, differing materially from each other, and demanding for their re-
moval important modifications in the nature of the remedial agents resorted to.
D. F. C.
XVII. .An Account of Jane C. Rider , the Springfield Somnambulist: the Substance
of which was Delivered as a Lecture before the Springfield Lyceum. By L. W.
Belde]s-, M. D. Springfield, 1834. pp. 134. 12mo.
Jane C. Rider, whose remarkable and interesting history is the subject of the
small volume before us, is in the seventeenth year of her age, and the daughter
of a respectable mechanic of Brattleborough, Vermont. In early infancy she
lost her mother, who died of some disease of the brain. Jane resided with her
father and the friends of her mother until April, 1833, when she removed to
Springfield, where she is represented to have secured the confidence and love
of all with whom she was connected.
** Her education is superior to that which is usually acquired by those oc-
cupying the middle rank in society. She is fond of reading, and especially
No. XXVllI.— August, 1834. 38
446 Bibliographical Notices.
delig-hts in poetry, her selections of which generally evince a chaste and cor-
rect taste. Though of a full habit, her appearance is prepossessing", and her
plump and rosy cheeks, by the unprofessional observer at least, would be re-
g-arded as the index of perfect health. She, however, has always been subject
to frequent head-aches, and other symptoms arising from an undue determina-
tion of blood to the head; and about three years since was, for several months,
affected with Chorea. A small spot on the left side of the head, near the region
which phrenologists assign to the organ of * marvellousness,' has since her
earliest recollection been tender^ or painful on pressure, and the sensibility is
much increased when she suffers from head-ache. During the paroxysms to
which she has lately been subject, this spot, at all times painful, is frequently
the seat of such intense agony as to induce her to exclaim, • It ought to be cut
open — it ought to be cut open.' Her eyes are so sensible to the light, that
she invariably suffers when she goes abroad in a clear day without a veil. From
her infancy she has been in the habit of sleeping more soundly, and a greater
number of hours, than is usual. She is seldom conscious of dreaming, and rare-
ly wakes of her own accord in the morning. In her childhood she was in the
habit of occasionally rising in her sleep, but did not manifest any of the peculiar
powers on those occasions which have since rendered her case so remarkable.*'
She was first attacked with the singular affection about to be described, on
the night of the 24th of June; it was then supposed that she was deranged. Dr.
Belden who was called in, found her struggling to get out of bed, complaining
very much at the same time of pain in the left side of the head. Her face was
flushed, head hot, eyes closed, and her pulse much excited. Attributing the
attack to the presence of undigested food in the stomach. Dr. Belden gave her
an active emetic, which brought away a large quantity of green currants, after
which she became more quiet, and soon fell into a natural sleep, from which
she did not awake until morning; when she was totally unconscious of every
thing that had passed during the night, and could scarcely be persuaded that
she had not slept quietly the whole time. After the lapse of nearly a mon'th she
was attacked with a second paroxysm, during which after several attempts to
keep her in bed, it vras determined to suffer her to take her own course, and
watch her movements. Released from constraint she dressed herself, went
down stairs, and proceeded to make preparations for breakfast.
" She set the table, arranged the various articles with the utmost precision,
went into a dark room and to a closet at the most remote corner, from which
she took the coffee-cups, placed them on a waiter, turned it sideways to pass
through the doors, avoided all intervening obstacles, and deposited the whole
safely on the table.
♦* She then went into the pantry, the blinds of which were shut, and the
door closed after her. She there skimmed the milk, poured the cream into
one cup and the milk into another without spiUing a drop. She then cut the
bread, placed it regularly on the plate, and divided the slices in the middle.
In fine, she went through the whole operation of preparing breakfast with as
much precision as she could in open day; and this with her eyes closed, and
without any light except that of one lamp which was standing in the breakfast
room to enable the family to observe her operations. During the whole time
she seemed to take no notice of those around her, unless they purposely stood
in her way, or placed chairs or other obstacles before her, when she avoided
them, with an expression of impatience at being thus disturbed.
** She finally returned voluntarily to bed, and on finding the table arranged
for breakfast when she made her appearance in the morning, inquired why she
had been suffered to sleep, while another had performed her duty. None of
She transactions of the preceding night had left the slightest impression on her
Belden's Account of Jane Rider ^ the Somnambulist. 447
mind — a sense of fatigue the following day being the only evidence furnished
by her conciousness in conformation of the testimony of those who saw her.'*
After this the paroxysms became more frequent, a week seldom passing with-
out two or three, but she was not always precisely similarly affected.
" Sometimes she did not leave her room, but was occupied in looking over
the contents of her trunk, and arranging the different articles of dress. She occa-
sionally placed things where she could not find them when awake, but some cir-
cumstances induced the belief that the knowledge of their situation was restor-
ed to her in a subsequent paroxysm. In one instance she disposed of her needle-
book where she could not afterwards discover it; but after some time had elapsed,
she was found one night in her chamber, sewing a ring on the curtain with'a
needle which she must have procured from the lost book.
" The entire paroxysm was sometimes passed in bed, where she sung, talked,
and repeated passages of poetry. Once she imagined herself at Brattleborough,
spoke of scenes and persons with which she was acquainted there, and described
the characters of certain individuals with great accuracy and shrewdness,
and imitated their actions so exactly as to produce a most comical effect. At
this time she denied ever having been at Springfield, nor could she be made
to recollect a single individual with whom she was acquainted here, except one
or two whom she had known in Brattleborough. Even the name of the people
with whom she lived seemed unfamiliar and strange to her.
** Generally her conceptions relative to place were, to a certain extent, cor-
rect— those relating to time were very commonly inaccurate. She almost inva-
riably supposed it was day,- hence her common reply when reminded that it
was time for her to retire, was, * What! go to bed in the day time?' And when
I say her notions relative to place were in accordance with fact, the statement
requires considerable limitation. She very frequently imagined herself in a dif-
ferent room from the one where she actually was, and almost always in the room
which she usually occupied when awake.
" Still her movements were always regulated by the senses, and not by her pre-
conceived notions of things. Her chamber was contiguous to a hall, at one ex-
tremity of which was the staircase. At the head of the stairs v/as a door which
was usually left open, but which was once closed after she was asleep, and fast-
ened by placing the blade ef a knife over the latch. On getting up, she rushed
impetuously from her room, and without stopping, reached out her hand before
she came to the door, seized the knife, and throwing it indignantly on the floor,
exclaimed, * Why do you wish to fasten me in ?'
"Without entering into minute detail, I will only mention some of the most
remarkable circumstances which occurred at this early period of the complaint.
" Allusion has been made to her sewing in the dark, and circumstances
render it almost certain that she must at that time have threaded her needle
also. Some time after this occurrence she conceived the plan, during a paroxysm,
of making a bag, in which, as she said, to boil some squash. She was then seen
to thread a needle in a room in which there was barely light enough to enable
others to perceive what she was about, and afterwards, the same night, she
was seen to do it with her eyes closed. In this condition she completed the
bag, and though a little puckered, as she observed, it still answered very well
to boil the squash in.
" In one instance she not only arranged the table for a meal, but actually pre-
pared a dinner in the night, with her eyes closed. She first went into the cellar
in the dark, procured the vegetables, washed each kind separately, brought in
the wood and made a fire. While they were being boiled, she completed the
arrangements of the table, and then proceeded to try the vegetables to ascertain
whether they were sufficiently cooked. After repeated trials, she observed the
smallest of them were done — she took them up, and after waiting a little, said
the rest would do, and took them up also. They were actually very well cook-
448 Bibliographical Notices.
ed. She then remarked that S., a little girl in the family, ate milk, and pro-
cured a bowl for her — she also procured one for herself and ate it. As the fa-
mily did not seat themselves at table, she became impatient, and complained
that the men never were ready for their dinner. While engaged in her pre-
parations, she observed a lamp burning in the room, and extinguished it, saying
* she did not know why people wished to keep a lamp burning in the day
time.' On being requested to go to bed, she objected, alleging, as a reason,
that it was day; but was persuaded to do so by being reminded that she was not
well, and that sleep would relieve her head. In the morning she appeared as
usual, totally unconscious of the transactions of the preceding night.
" At first, the paroxysms occurred only in the night, and generally soon after
she went to bed. As the disease advanced, they commenced earlier — she then
fell asleep in the evening, sitting in her chair — or rather passed into the state
of somnambulism; for her sleep, under these circumstances, was never natural.
At a still later period, the attack took place at any hour during the day or
evening. After she began to be affected in the day time, the fit seldom com-
menced when she was in bed; and even when she retired, as she often did, in
this state, she usually remained quiet till the paroxysm subsided — though at
times she continued to talk and sing. Sometimes she suffered two distinct pa-
roxysms in one day.'*
The following is the general description as given by Dr. Belden, of the pa-
roxysms during that period of the disease in which the extraordinary acuteness
of vision was manifested — after this was lost, most of the other symptoms were
less marked, and many of them disappeared entirely.
** The state of somnambulism was usually preceded by a full, heavy, unplea-
sant feeling in the head — sometimes by head-ache, ringing in the ears, cold ex-
tremities, and an irresistible propensity to drowsiness, attended with a feeling
as if weights were appended to the eyelids. There was almost always a slight
contraction of the eyebrows, the cheeks were flushed, and sometimes tinged
with a crimson hue. By great exertions, the fit might be put off for hours after
the appearance of these symptoms; but, in order to gain this reprieve, it was
necessary for her to walk, or be engaged in some active employment. The
most effectual preventive was exposure to the open air. The moment these
precautions were relaxed, and sometimes even in the midst of her active du-
ties, she experienced what she described as a sense of rushing to the head, at-
tended with a loss of the power of speech and motion. If in this state she was
immediately carried into the open air, the fit was often arrested; but if this was
delayed a moment too long, she lost all recollection, and could not by any ef-
forts be aroused. To a spectator she appeared like a person going quietly to
sleep. Her eyes were closed, the respirations became long and deep, her atti-
tude, and the motions of her head, resembled those of a person in a profound
slumber. During the fit, the breathing, though sometimes natural, was often
hurried, and attended with a peculiar moaning sound, indicative of suffering.
At times the pulse was accelerated, but generally it did not vary much from
the natural standard. I have remarked, that in her first paroxysm the head was
hot, but such was not commonly the case, nor was there any peculiar throbbing of
the temporal arteries — the hands andfeet, however, were almost invariably cold.
*' Her manner differed exceedingly in different paroxysms. Sometimes she
engaged in her usual occupations, and then her motions were remarkably quick
and impetuous— she moved v/ith astonishing rapidity, and accomplished what-
ever she attempted with a celerity of which she is utterly incapable in her na-
tural state. She frequently sat in a rocking-chair, at times nodding, and then
moving her head from side to side with a kind of nervous uneasiness, the hand
and fingers being at the same time affected with a sort of involuntary motion.
In the intervals of reading or talking, and even when engaged in these very
acts, her nods, the expressions of her countenance, and her apparent insensi-
Belden's Account of Jane Rider, the Somnambulist. 449
bility to surrounding" objects, forced upon the mind the conviction that she was
asleep. Occasionally she was cheerful, disposed to talk, and willing- to exer-
cise her powers; the greater part of the time she was irritable and petulant.
Pain in a circumscribed spot on the left side of the head was, I believe, always
an attendant on the paroxysm, and frequently occasioned a degree of suffering
almost beyond endurance. To this spot she invariably pointed as the seat of
her agony when she repeated the expression, ** it ouglit to be cut open, it
ought to be cut open." Occasionally the whole system was thrown into agita-
tion, and she presented the appearance of a person in a violent fit of hysterics.
" Her eyes were generally closed, but at times they were stretched widely
open, and the pupil was then very considerably dilated. These different states
of the eye seemed to occasion no difference in the power of seeing — she saw
apparently as well when they were closed as she did when they were open. In
the day time she always had the eyes covered with a bandage during the pa-
roxysm, nor would she allow it to be removed for a single moment, unless the
room was unusually dark. In order to test the sensibility of the eye, I took
one evening a small concave mirror, and held it so that the rays proceeding
from a lamp were reflected upon her closed eyelid. When the light was so
diffused that the outline of the illuminated space could scarcely be distinguish-
ed, it caused, the moment it fell on the eyelid, a shock equal to that produced
by an electric battery, followed by the exclamation, ' vi^hy do you wish to shoot
me in the eyes?' This experiment was repeated several times, and was always
attended with the same result. It was also tried when she was awake, and the
effect, though less striking, was very perceptible. The same degree of light
thrown on my eyelids, occasioned no pain.
'* How far she was sensible to the presence of surrounding objects, it is very
difficult to determine; indeed, facts seem to prove that she was not, in every
paroxysm, alike in this respect. In the early stage of her complaint, she ap-
peared to take little notice of persons, unless they were connected with her
train of thought, and then she regarded those with her only as the represen-
tatives of the persons whom she imagined to be present. Nor did the sight or
the hearing have any tendency to correct the false impression. Thus, in her
first paroxysm, she regarded me as her father, and continued to do so as long
as I remained with her; but, in her subsequent fits, this idea was never revived.
Her conception of persons was generally made to correspond with the idea of
the place in which she conceived herself to b'e. She v/as in the habit, when
well, of spending her evenings in the room with the children of the family, and
it was in their company that she often imagined herself to be during the pa-
roxysm. The questions which were at these times proposed to her to test her
powers of vision, were cheerfully and readily answered, because they were
questions which it was natural for children to ask; or, at least, she supposed
them to proceed from children. Much that she said was also directed to them,
though it was evident, at times, her conceptions and perceptions were strange-
ly intermingled. In a paroxysm, soon after the arrival of her father, he asked
her a question which she answered by addressing a little boy belonging to the
family, who was not then in the room; but his knife which he placed in her
hand, she immediately recognised as her father's, and wondered how that came
to be in Springfield while he was in Braltleborough. At a later period of her
complaint; she appeared to comprehend more of what transpired in lier pre-
sence, and accordingly she obstinately refused to read cards, or submit to ex-
periments of any kind. These trials she then evidently regarded as so many
attempts to impose upon her; and in adopting this conclusion she reasoned with
perfect consistency; for if she actually could see as she appeared to^ — if to her
vision, night was converted into day, and darkness into light, while she was un-
conscious of any thing peculiar to herself, what could be more annoying than
to be constantly teased with questions which to her senses were perfectly ob-
vious? If a request were made of her which appeared reasonable, especially
if it related to her customary duties, she really did whatever was required,
38*
450 Bibliographical Notices,
"There is abundant evidence that she recollected, during- a paroxysm, cir-
cumstances which occurred in a former attack, thoug-li there was no remem-
brance of them in the interval. A single illustration will suffice, though many
more might be given. In a paroxysm, a lady who was present placed in her
hand a bead bag- which she had never before seen. She examined it, named
the colours, and compared them with those of a bag* belonging to a lady in the
family. The latter bag being- presented to her in a subsequent paroxysm, the
recollection of the former was restored — she told the colours of the beads, and
made the same remarks respecting the comparative value of the two bags that
she had done before. I had taken measures to satisfy myself in the interval that
she then remembered nothing of the first impression.
" Attempts to rouse her from this state were uniformly unsuccessful. She
heard, felt, and saw; but the impressions which she received through the senses
had no tendency to waken her. A pailful of cold water was in one instance
thrown upon her; she exclaimed, * Why do you wish to drown me!^ — went to
her chamber, changed her dress, and came down again. Large doses of lauda-
num were sometimes given her with a view to relieve her pain— it appeared to
mitigate her sufferings, and she was observed uniformly to wake soon after-
wards. Excitements of every kind, and particularly attempts to draw forth her
peculiar powers, invariably prolonged the fits, and generally aggravated the
pain in the head.
" At the termination of a paroxysm, she sunk into a profound sleep. The
frown disappeared from her brow, the respirations again became long and deep,
and the attitude was that of a person in undisturbed slumber. She soon began
to gape and rub her eyes, and these motions were repeated after short intervals
of repose. In the course of fifteen or twenty minutes from the first appearance
of these symptoms, she opened her eyes, when recollection was at once re-
stored. She then invariably reverted to the time and place at which the attack
commenced, and in no instance, when under my care, manifested any knowledge
of the time which had elapsed, or the circumstances which transpired during
the interval.
" These paroxysms were very obviously connected with the state of the sto-
mach and digestive organs. Though the appetite was generally good, food
often occasioned oppression, and she not unfrequently raised a considerable
portion of what she ate. She also had head-ache, acidity of stomach, and most
of the symptoms usually termed dyspeptic. These circumstances had not in-
deed attracted much attention till after the occurrence of the paroxysms; but I
then found that they had existed, in a slight degree, for some time, and that
lately her sufferings from this source had been very considerably aggravated.
Improper food, and other causes affecting the stomach directly, I am confident,
in several instances, occasioned an attack. The very first paroxysm occurred a
few hours after she had eaten a large quantity of green currants; and two or
three times afterwards, a paroxysm was occasioned by medicine which disturb-
ed the stomach.
" During the fit she very often called for food, particularly for apples; but she
seldom woke as soon as usual, after having gratified her appetite. At a time
when she had invariably one or two paroxysms daily, T gave her an emetic, and
afterwards allowed her to take but a small quantity of the simplest food; under
this course she had but one shght attack for five days, and she was in every res-
pect much better. The paroxysm which she had in this instance occurred also
under circumstances illustrative of the nature of the complaint. It came on in
the stage, when she was on the way to Worcester, and was .jfi-eceded by sick-
ness, to which she is very subject when riding in a close carriage.'*
The family in which Jane lived were early convinced from the confidence
\rith which she moved, and the facility with which she always avoided obstacles,
that she saw both when her eyes were closed and in the dark, but no experi-
ments were instituted to determine the fact until the evening of the 10th of No-
Belden's Account of Jane Rider, the Somnamhiilist. 451
vember, when it was proposed to ascertain whether she could read with her
eyes closed.
" She was seated in a corner of the room, the lights were placed at a dis-
tance from her, and so screened as to leave her in almost entire darkness. In
this situation she read with ease a great number of cards which were presented
to her, some of which were written with a pencil, and so obscurely, that in a
faint light no trace could be discerned by common eyes. She told me the date
of coins, even when the figures were nearly obliterated. A visitor handed her a
letter, with the request that she would read the motto on the seal, which she
readily did, although several persons present had been unable to decipher it
with the aid of a lamp. The whole of this time the eyes were, to all appear-
ance, perfectly closed.
" The second day after this exhibition of her power, she fell asleep in the
morning in the act of procuring water from the pump. This was her first attack
in the day time. Soon after, on going out of doors, she observed to her com-
panion, * what a beautiful day it is, how bright the sun shines!' It was in fact
quite cloudy. When asked by one of the ladies of the family to thread a needle,
she refused, saying, *you can do it for yourself.' Soon after, she went into
a neighbouring house, where there was an elderly lady to whom she often ren-
dered this kind of assistance. This lady said, 'Jane, I am old, and cannot see
very well, will you thread my needle for me?' She immediately complied with
the request, and threaded the needle not only at that time, but once or twice
afterwards. She awoke from this paroxysm in the afternoon, and was quite
distressed to find the fits beginning to affect her in the day time.
** The next morning she fell asleep while I was prescribing for her, and her
case having now excited considerable interest, she was visited during that and
the following day by probably more than a hundred people. To this circum-
stance, undoubtedly, is to be attributed the unprecedented length of the pa-
roxysm: for she did not awake till Friday morning, forty-eight hours after the
attack. During this time she read a great variety of cards written and presented
to her by different individuals, told the time by watches, and wrote short sen-
tences.
** For greater securlt}', a second handkerchief was sometimes placed below
the one which she wore constantly over her eyes, but apparently without caus-
ing any obstruction to the vision. She also repeated with great propriety and
distinctness several pieces of poetry, some of which she had learned in child-
hood, but had forgotten, and others which she had merely read several years
since without having ever committed them to memory. In addition to this she
sung several songs, such as * Auld Lang Syne' and ' Bruce's Address to his
Army,' with propriety and correctness. Yet she never learned to sing, and
never has been known to sing a tune when awake. She was evidently very
much exhausted by these efforts, and at times her sufferings were so extreme
that she could not be induced to answer any questions.
** On Wednesday, November 20th, I took a large black silk handkerchief,
placed between the folds two pieces of cotton batting, and applied it in such
a way that the cotton came directly over the eyes, and completely filled the
cavity on each side of the nose — the silk was distinctly seen to be in close con-
tact with the skin. Various names were then written on cards, both of persons
with whom she was acquainted, and of those who were unknown to her, which
she read as soon as they were presented to her. This was done by most of the
persons in the room. In reading she always held the paper the right side up,
and brought it into the line of vision. The cards were generally placed in her
hand for the purpose of attracting her notice, but when her attention was ex-
cited she read equally well that which was held before her by another. I do
not know that she ever read cards which she had never seen, when only the back
was presented to her.
** Being desirous, if possible, to prove that the eye was actually closed, I
452 Bibliographical Notices.
took two large wads of cotton, and placed them directly on the closed eyelid,
and then bound them on with the handkerchief before used. The cotton filled
the cavity under the eyebrow, came down to the middle of the cheek, and was
in close contact with the nose. The former experiments were then repeated
without any difference in the result. She also took a pencil, and, while rock-
ing- in her chair, wrote her own name, each word separately, and dotted the i.
Her father, who was present, asked her to write his name. * Shall I write
Little Billy or Stiff Billy,' was her reply, imagining that the question was pro-
posed by a little boy of the name of William belonging to the family. She
wrote Stiff Billy — the two words without connexion, and after writing thera
both, she went back and dotted the i in each. She then wrote Springfield
under them, and after observing it a moment, smilingly remarked that she had
left out a letter, and inserted the 1 in the proper place.
"A watch enclosed in a case was handed to her, and she was requested to
tell the time — after examining both sides, she opened the case, and then an-
swered the question. Afterwards, but in the same paroxysm, a gentleman pre-
sent wrote his name in characters so small that no one else could distinguish it
at the usual distance from the eye. As soon as the paper was put into her hand,
she pronounced the name. It was thought that any attempt to open the eye
would be indicated by the contraction of the skin on the forehead, but though
she was closely watched, nothing of the kind was observed.
" She also at this time repeated poetry and sung, as before. This she did
almost every paroxysm; and though there are some pieces which she must have
repeated in this way scores of times, her knowledge of them when she is awake
is not in the least improved by the practice. These experiments were perform-
ed in the presence of several of the most respectable and intelligent gentle-
men in town, and they were all convinced there could be no deception.
'« While she was in a paroxysm a few evenings afterwards, the lights were
removed from her room, and the windows so secured that no object was dis-
cernible. Two books were then presented to her which had been selected for
the purpose; she immediately told the titles of both, though one of them was a
book which she had never seen before.
" Monday, Nov. 25th, she was removed to my house; but, though she had se-
veral paroxysms in the interval, nothing worthy of notice occurred till the 30th,
The morning of that day, as she was engaged in her customary employments,
she complained suddenly of dizziness, seated herself in a chair, and immediate-
ly became insensible. Soon after, she applied a bandage to the eyes, went to
her chamber and changed part of her dress. She then came down, and taking
a basket which she had purchased the day before, and which was much soiled,
remarked that it was dirty, and she would wash it. This operation she per-
formed with as much neatness and despatch as she could have done when awake.
" The room in the front part of the house she had never seen except for a
few moments several months since. The shutters were closed, and it was so
dark that it was impossible for any one possessing only ordinary powers of
vision to distinguish the colours in the carpet. She, however, though her eyes
were bandaged, noticed and commented on the various articles of furniture,
and pointed out the different colours in the hearth rug. She also took up, and
read several cards which were lying on the table. Soon after, observing her
with a skein of thread in her hand, I offered to hold it for her to wind. She
immediately placed it on my hands, and took hold of the end of the thread in a
manner which satisfied me she saw it, and completed the operation as skilfully
and readily as if she were awake. Having left the room a. moment, I found her
on my return with her needle threaded, and hemming a cambric handkerchief.
She however soon abandoned her work, and was then asked to read a little
while aloud. Bryant's Poems were given to her; she opened the book, and
turning to the * Thanatopsis,' read the whole, (three pages,) and the most of
it with great propriety. Something being said about her manner of reading,
she observed there were parts of the piece which she did not understand, that
Belden's Jiccount of Jane Rider, the Somnambulist, 453
she could read it much better if she understood it. The day before, she had
procured several samples of calico at the shops, portions of some of which had
been washed since the commencement of her paroxysm. On their being- spread
out before her, she not only told the shop at which she obtained each, and named
its price, but compared the part which had been washed with the piece from
which it was taken, and when there was any chang-e, pointed out the difference.
"A coloured g-irl came in and seated herself before her: she was asked if she
knew that lady; she smiled, and returned no answer. Some one said, ' She has
a beautiful complexion, has she not?" Jane laughed heartily, and said, * I should
think she was somewhat tanned.'
" At dinner she took her seat at the table as usual, helped herself to bread
when it was oifered, presented her tumbler for water, and through the whole
time, did not, by her manner or actions, betray the least want of sight. After
dinner the bandage which she put over her eyes in the morning-, and which she
had worn ever since, was taken off, and in its place a black silk handkerchief
stuffed with cotton was bound on so as to fit accurately to the nose and cheeks.
Though extremely reluctant on account of severe pain in the head, she was at
length prevailed on to write a part of the ' Snow Storm,' one of the pieces which
she is in the habit of repeating- when asleep. She finished one stanza of sis
lines, and part of a second. In writing she followed for a time the ruled lines
placed under her paper, but they having- been displaced, she proceeded with-
out them, continuing-, however, nearly in a straight line. In one or two in-
stances she failed to make a proper division of the poetry into lines, and several
times misspelled words which she would not have done had she been awake.
Twice she noticed the inaccuracy in the spelling-, and corrected it at the time,
but when writing the same words afterwards she fell into a similar error. A
person standing- behind her very carefully interposed a piece of brown paper
between her eyes and the paper on which she was writing-. "Whenever this was
done she appeared disturbed, and exclaimed, ' don't, don't.' For some time I
watched her narrowly to ascertain whether the bandage was constantly in place,
but I could detect no change in its position.
** A watch was presented to her, the face of which was concealed by a piece
of brown paper placed between it and the chrystal. Instead of telling the time,
she observed, * Any thing but a paper watch !'
" In the evening, when the room was so dark that nothing but the position
of the windows could be discerned by common eyes, a blue fancy handkerchief
was placed before her, and she was asked if she did not wish for a beautiful
pink handkerchief^she replied, *I hope I know blue from pink.'
" The next day, during a paroxysm, she went into a dark room and selected
from among several letters, having different directions, the one bearing the
name which she was requested to find. She was heard to take up one letter
after another and examine it, till she came to the one for which she was m
search, when she exclaimed, * Here it is,' and brought it out. She also, with
her eyes bandaged, wrote of her own accord two stanzas of poetry on a slate ;
the lines were straight and parallel.
" One circumstance I have omitted to mention, which is, the power of imita-
tion which she occasionally exhibits. This extends not only to the manner, but
to the language and sentiments of the persons whom she personifies: and her
performances in this way are so striking, and her conceptions of character so
just, that nothing can be more comical.
" This, like her other extraordinary powers, is confined to the somnambulist
state — at other times she does not exhibit the slightest trace of it."
Jane's disease being manifestly aggravated by the constant trials of her pecu-
liar powers, she was removed to the hospital in Worcester on the 5th of Decem-
ber, 1833. The following abstract from the record book of this institution ex-
hibits the progress of the case, and confirms the observations relative to her re-
raarkable powers of vision.
454 Bibliographical Notices.
"Jane had no paroxysm till the evening of December 6th, the day after her
admission. * Immediately after faUing* asleep she began to breathe with diffi-
culty, her mind seemed to labour, and she was uneasy and in perpetual motion.
She said nothing till questions were asked her. She told the time of day by a
watch, in the dark, with her eyes closed — the fire was not extinguished, and of
course it was not entirely dark. Her pulse was 72 in a minute, and without ir-
ritation. She answered questions regularly, but with an air of impatience; and
said * they kept asking her to read, but she would not.' She declared she
would not go to Worcester, and said she was at Mr. Stebbin's in Springfield.
Afterwards she complained she was locked up in the hospital, and did not wish
to stay, and that she would not have come here if she had expected to be lock-
ed up. One hour and a half after the commencement of the paroxysm, her feet
was placed in a bath of the nitro-muriatic acid. In five minutes she became
calm, and went mto a quiet sleep: in a few minutes more she waked very
pleasant.'
*' From this time till the 13th, she had from one to three paroxysms daily;
in some of which * she repeated passages of poetry very sweetly; sung some
tunes with correctness; and, with her eyes bandaged, walked about the house,
and from room to room, without inconvenience.' Many of these paroxysms, the
Doctor observes, he is now satisfied were occasioned by improper food, parti-
cularly by the free use of fruit.
" * Dec. 13. Jane had a more interesting paroxysm than at any time before
since her residence in the hospital. In a paroxysm the day previous, she lost a
book which she could not afterwards find. Immediately on the access of the
paroxysm to day, she went to the sofa, raised the cushion, took up the book,
and commenced reading. She read two or three pages to herself. Her eyes
were then covered with a white handkerchief folded so as to make eight or ten
thicknesses, and the spaces below the bandage filled with strips of black vel-
vet. She then took a book and read audibly, distinctly, and correctly, nearly a
page. It was then proposed to her to play backgammon. She said she knew
nothing of the game, but consented to learn it. She commenced playing with
the assistance of one acquainted with the moves, and acquired a knowledge of
the game very rapidly. She handled the men and dice with facility, and count-
ed off the points correctly. Had another paroxysm in the afternoon in which
she played a number of games of backgammon, and made such proficiency that,
without any assistance, she won the sixth game of Dr. Butler, who is an experi-
enced player. Knowing her to be a novice, he suggested several alterations
in her moves — these alterations she declined making, and the result showed the
correctness of her judgment. The Doctor, a little mortified at being beaten by
a sleeping girl, tried another game, in which she exerted all his skill. At its
close she had but three men left on the board, and these so situated that a single
move would have cleared the whole. While she was engaged in this game, an
apple was taken from a dish, in which there were several varieties, and held
before her, but higher than her eyes. On being asked its colour, she raised her
head, like a person who wished to see an object a little elevated, and gave a
correct answer to the question. In the lucid interval, half an hour after she
awoke from the paroxysm, it was proposed to her to play backgammon. She
observed she never saw it played, and was wholly ignorant of the game — on
trial it was found she could not even set the men.'
" * Dec. 15. Paroxysm rather singular. She is full of mischief like a roguish
child — is very pleasant all the while, but will not read. At twilight her eyes
were more open than common, but she insisted she could not see. Ate too
heartily and felt sickness at stomach.*
*' * Dec. 16. Has been different in the paroxysms to-day. She opens her eyes
and declares she cannot see, when they are shut. When reading, I placed my
fingers on her eyes — she said immediately it was total darkness, and she could
not read a word. The fact that her eyes arc open in the paroxysms proves that
they are less susceptible to light, and of course that her vision is less acute. At
Belden's Account of Jane Rider ^ the Somnambulist, 455
dinner her eyes were open, and all the family supposed her awake; but she de-
clared in the evening she had not the least recollection of dining-, of seeing-
some friends, or of witnessing a catastrophe in the gallery which disturbed the
whole family, and in which she was much interested at the time.*
*' ' Dec. 18. In the paroxysm this evening her eyes are open, and she ap-
pears, in all respects, like a person awake; yet her manner is very different from
that which she usually exhibits. She evidently has lost her former acuteness of
sight — she protests she can see nothing when blinded, and will not attempt the
least thing.*
" * Dec. 19. During the whole day the appearance was the same as on previ-
ous days, excepting her mind was more tranquil, and she was more disposed to
melancholy. She once said her head ached, and felt strangely. She appeared
very much like a person insane. I gave her a letter about four o'clock, which
she read, and remarked that she did not know that her friends expected her to
write to them. At nine o'clock she was asked if she had seen a letter from
Springfield; she denied that she had, but recollected circumstances which trans*
pired yesterday; -and, in this respect, was different from what she usually ig
during the paroxysm. A stranger would say, you have got an odd or insane
girl, but would suspect nothing more. My family disagreed about the time of
her coming out of the paroxysm; one thought she was out of it when others
thought not.'
" * Dec. 21. Very well, and wakeful all day, but in the evening had a pa-
roxysm of complete insanity: talked, ran about the house, and refused to take
her medicine. When forced to take it she shed tears, and fell into a sort of hys-
terical sobbing, which lasted some minutes.'
" * Dec. 24. Had a paroxysm in the evening, in which she played backgam*
mon: at first her eyes were closed, afterwards wide open. She said she could
not read a word or see at all when blinded. Lately her face has been less
flushed, and her head less painful.'
'* ' Dec. 30. In a paroxysm to-day she wrote the following letter to her aunt!
She afterwards remembered that she had written a letter, but could not recol^
lect its contents.'
'* Deau Aunt,
** I feel that it is my duty to write to you, and inform you of my situation^
as it is a very critical one. I received a letter from father yesterday, saying he
had not written to you, and wished me to do so. I thought I would try. Per-
haps you will wonder how I came to Worcester Hospital — but it is for my health.
As I prize that above everything else, I was willing to deny myself a great many
pleasures only for a few months. I left home last April, and went to Springfield
with a young lady of my acquaintance, and liked there so well that I concluded
to stay and spend the summer. While there I was attacked with the disorder
that has brought me to the hospital. The first attack was in June. It was about
ten in the evening — the people called a physician; he thought it was partial de-
rangement, and gave me an emetic that stilled me a little, and I got over it,
and the next day was quite well. The people thought it was a very strange
disorder, and let it pass off. But I was troubled almost every week with the
same disorder, and it soon became something serious. I found I was growing
worse every day, and was put under the physician's care. Medicine did not
seem to have any effect, and I was still growing worse. In October I was at-
tacked in the day time. It was Tuesday morning, and it continued till Friday
morning, when I went into a natural sleep, and awoke up and knew nothing of
what had passed. I will not try to give you any description of what I did, as I
presume you have read it in the newspapers, as my case was the one referred
to, and I think the pieces are not exaggerated in the least.
" Father was sent for when I was in one of my turns, as I do not know what
else to call them, and reached Springfield in about 48 hours; and an hour after
I came out of it. He expected to take me home with him; but I was taken the
456 Bibliographical Notices.
next morning", and continued so most of the time he was in Springfield. He
said it was no place for me at home, and there must be something done. They
then concluded to bring- me here, as people thought if I could be cured any-
where it would be here; and I am happy to say I am much better than I was
when I came here. I have been here about a month, and I think I shall be
entirely well in two months more, as my turns are not near as often, and no two
have been alike. The people of Springfield were so much interested for me,
that they offered to pay my board here until I was well? so the night I left
Springfield I had a present of forty-eight dollars."
« In the evening of the day on which she wrote the letter she had a very dis-
tressing paroxysm, which was followed by a mild form of fever which lasted se-
veral days. '*
" 'Jan. 10. Did not feel well all day yesterday — had confusion of head and
flushing of face. At evening she had a paroxysm in which she recollected all
that was done in the day; and after the paroxysm all that was done in it. It last-
ed but half an hour, when she went into a quiet sleep and slept till morning.'
" ' Jan. 11-13. Had shght paroxysms in which consciousness was not lost —
recollected in the paroxysms what transpired in the interval, and in the interval
the circumstances of the paroxysm — is greatly inclined to indulge in eating,
and if she eats freely is unusually dull and sleepy afterwards.'
" * Jan. 19. Has had one or two paroxysms since the 13th similar to those
last described. In the one to-day she repeated the * Pilgrim's Fathers' very dis-
tinctly and correctly. I had censured her for eating fried cakes and the like be-
tween meals; and she kept a fast during the paroxysm to-day, but called for
pancakes, which she said might be eaten with impunity on fast-days.' "
During a recent visit to Worcester, Dr. Belden had an opportunity of wit-
nessing the improvement in the health of his patient.
" Her face has lost the fiush which it used habitually to wear — the head is
tiow seldom painful, and there is no tenderness at the spot formerly affected,
and the natural, healthful temperature of the extremities has been restored.
There is still some oppression after eating, especially if she deviates from the
regulations which have been prescribed respecting her diet; and any gross vio-
lation is almost certain to be followed by a paroxysm. Strong mental emotion
too, or any kind of mental or physical excitement, conduces to the same effect;
and, sometimes, is of itself sufficient to occasion a fit. In a paroxysm which oc-
curred while I was there, the eyes were open and appeared nearly natural — the
pupil was, perhaps, a little more dilated than common. Her manner was
hurried — the speech and motions rather quick and abrupt. She appeared to
be sensible of every thing which took place around her, — knew me, and an-
swered my questions with propriety and correctness; and, so far as I could dis-
cover, had a proper conception of the relations of time and place. A hand-
kerchief having been tied over her eyes she declared she could not see at all —
said that it was perfect darkness to her. During the whole time her percep-
tions appeared to be more quick and vivid than natural. Her remarks, as in
the earlier periods of her disease, were often distinguished for a degree of wit
and brilliancy peculiar to these occasions. She also, at this time, sung as she
formerly did. In the paroxysm she recollected circumstances which transpired
a short time before, but did not, the next day, remember what occurred in the
fit. The termination of the paroxysm is often less distinct than it formerly was,
though the access, I believe, continues to be well marked."
The latest intelligence we have of the case is contained in the following ex-
tract of a letter from Dr. Woodward to Dr. Belden.
"Jane's paroxysms have ceased altogether for the last nine days, and she is
in good health, excepting a distress after taking food. She has never appeared
Belden's Jlccount of Jane Rider ^ the Somnambulist. 457
so cheerful, and in so good spirits, since her residence with us. During- nnost
of last week she did the duty of an assistant in the absence of one of our attend-
ants, and she has done more or less work in the halls every day. During* the
last paroxysm I applied leeches to her head. She waked during the paroxysm
not a little surprised at her new head ornaments"
Such is the history of this remarkable case, which we have presented in all
its details, conceiving" them as we do to possess extreme interest. We have not
considered the question of imposture in the case, entertained by some who are
jg-norant of physioiog-y and of the records of medicine, because we really enter-
tain no suspicion of deceit. Independent, in this case, of the care with which
the facts appear to have been observed, the respectabihty of the witnesses, the
character of the patient, the nature of the facts observed precluding- the idea of
imposition, and the analogous cases in medical records, there appears to us no-
thing so unprecedented as to excite our incredulity. Physiology, indeed, clear-
ly points to an excited state of certain portions of the brain, as offering an ex-
planation of most of the remarkable phenomenon of the case.
We placed a handkerchief eight times folded over the eyes of a medical
friend, who expressed his disbelief in the possibility of any object being dis-
cernible through such an envelope, and to his surprise he could distinguish the
position of the windows, and on a subsequent occasion the light of a lamp in
the room. Now, the retina and cerebral organs of our friend were in a normal
condition, and if in this state he could distinguish the hght through so many
folds of linen, it seems little extraordinary that an individual whose cerebral
organs of vision are in a state of extreme excitement should be capable of dis-
tinguishing objects much more distinctly. Light and darkness are but compa-
rative terms. It is familiar to every one that a person on entering a room dimly
lighted will pronounce it perfectly dark, and yet in a ^ew minutes be able to
distinguish minute objects. Persons long confined in dungeons so dark that the ,
visitor pronounces that no ray of light enters, have after a time been enabled
to distinguish objects, and even to watch the movements of m.inute insects; as of
spiders. Sec. Nor is the fact less familiar to the physician, that patients labour-
ing under retinitis will complain of the light, and even severely suffer from it
in a room which to a healthy eye seems totally dark.
We may call attention also to the extraordinary acuteness of the other senses
in certain individuals, as of the sense of hearing and of touch in the blind; and
still more so in those labouring under inflammation of the auditory and tactile
organs. The case of Caspar Hauser furnishes us also with evidence of an acute-
ness of some of the senses quite as surprising as occurred in the one under no-
tice. There appears to us, then, nothing incredible in what has excited most
surprise in Jane's case, her acuteness of sight, and although we cannot so satis-
factorily explain all the other phenomena, this does not afford sufficient ground
for disbelief, inasmuch as they are not in opposition to any of the established
laws of nature.
There are innumerable other phenomena equally extraordinary and inexpli-
cable, and which no one questions, but which only cease to excite our surprise
because of their frequent occurrence — as intermittence in fevers, the perfect
regularity of the paroxysms, 8cc.
No. XXVIIL— August, 1834. 39
458 Bibliographical Notices.
XVIJI. Clinical Observations on the Constitutional Origin of the various Forms of
Porrigo, commonly known^hy the names of tScald-head, Tinea, Ring-vcorm, &c.
With Directions for the more Scientific and successful Management of this
usually obstinate class of Diseases by a Treatment consisting of an Appropriate
Modification of the Principles first particularly promulgated by Mr. Mernethy.
By George Macilwai^t, Surgeon to the Finsbury Dispensary, St. Ann's So-
ciety, and late Surgeon to the city of London Truss Society. London, 1834.
A thin octavo of 83 pages, heavily leaded and amply margined, — a volume
which will not call forth from the reader the trite adage of mulium in parvo.
The author inculcates the necessity of a mild diet in the treatment of porrigo;
and as every physician called upon to prescribe for the same affection recom-
mends the same thing, no one will be inclined to dispute this point with him.
Occasional mild purgatives, keeping the head shaved, and the application to it
of weak red precipitate ointment, constitute the sum of the medical, general,
and local treatment. In all this there is certainly nothing new 5 neither do we
perceive any thing novel in his views relative to the philosophy of the disease.
We have been a little puzzled by some of his passages, of which the following
may serve as a specimen. Upon the subject of the varieties of porrigo, all of
which he conceives are to be relieved by a similar treatment, he observes —
*' Modifications in the treatment are certainly required; these, however, re-
sult, not from any difference in the local characters of the complaint, but from
the variations which occur in the seat, and in the indications of the general dis-
order by which they are accompanied, to which may be added those obviously
suggested by difference of age, and certain constitutional peculiarities."
We shall cite another exampJe of carelessness in writing. In regard to the
tate of the stomach in porrigo, he observes —
"I have not often found it necessary to interfere medically with this organ,
further than in the correction of voracious appetite, which sometimes exists in
such a degree, as greatly to irritate the nervous system. I believe that this
would, in many cases, gradually subside under the influence of a rational diet
alone? but its relief is much expedited by the administration of small doses of
ipecacuanha or antimony — one grain of the former, or two or three grains of the
latter, may be given every night with half a grain of calomel and the rhubarb,
with great advantage."
Here the " two or three grains of the latter," should certainly allude to the
ipecacuanha, and not the tartrite of antimony, as expressed. Following the
advice of the text might occasion some inconvenience to a child or person with
a very feeble stomach.
The following passage deals in those " elementary truisms" for which the
author is distinguished. In cases where worms exist in the alimentary canal,
he observes, that he trusts to repeated small doses of aloes and calomel.
"I prefer these, because, as it appears to me, I not only produce the dis-
charge of these animals with certainty, but they do not so readily again make
their appearance. We know but little about these animals; but could we dis-
cover it, the object in treating them is evidently not only to procure their ex-
pulsion, but to correct, at the same time, the morbid condition which favours
their production, and on which it may possibly depend."
Mr. Macilwain's little book is, however, by no means a bad one. The prac-
tice it inculcates is not only simple and safe, but calculated to be efficacious.
He deserves special commendation for one thing, namely, dispensing with the
Biancini on Connexion between Mother and Foetus. 459
farrago of ointments and washes usually recommended in the treatment of the
forms of porrigo, some of which are exceedingly dirty and disgusting, especially
such as contain tar and sulphur. That many of the local applications often re-
commended are not only useless, but positively injurious, we fully believe, be-
ing in general too irritating and unsparingly used. The applications or treat-
ment should never be such as would interfere with the healthy functions or
conditions of the parts affected, and we fully concur with the author in the
opinion, that unnecessary rudeness of manipulation, either in washing, shaving,
or drying the head, will each contribute to render the disease more or less ob-
stinate. The following advice upon this subject is highly judicious.
" The head having been shaved as close as the nature of the case may ad-
mit, should be washed with soap and water, until every particle of discharge be
removed. The soap should next be entirely washed off by a liberal use of
clean tepid water, and the whole surface patted, (not rubbed,) with soft linen
until perfectly dry. I generally direct the head to be shaved about twice a
week."
The ointment employed, which is generally the red precipitate, made at
first of the strength of a drachm to an ounce of lard, and gradually increased,
should be applied by means of a moderate sized camel-hair brush —
" With such an instrument the whole of the affected surface should be, as it
were, lightly painted; the ointment having been previously conveniently
softened by warmth, so that the diseased parts should appear as if lightly oiled
by the application, and nothing more. The dressing should be repeated night
and morning, with the same care to cleanse the surface of all matters, including
the ointment previously employed. In some instances this frequent dressing-
seems to produce irritation? when repeating it once in twenty-four hours may
be sufficient, especially if the renewal of the discharge be not very rapid or
abundant."
We have indulged in a freer notice of this little treatise, from the belief that
it will not be republished in this country. G. E.
XIX. Sul Commercio Sanguigno tra la Madre et il feto Lezione dl Tommaso
BiANciifi, Prosettore e Ripetitore di notomia umana nelP I. E. R. Univer. di
Pisa, &c. detta all' Academia Medico-Fisica Fiorentia Nell' adunanza del di
9 Dicembre, 1827. Pisa, 1833. 8vo. pp. 78.
On the Sanguineous Connexion between the Mother and Foetus. By Thomas
BiAKciNi, of Pisa, read before the Medico-Physical Academy of Florence at
its Session of December 9th, 1827.
The mode in which the communication is effected between the blood of the
mother and that of the foetus, has given rise to very considerable controversy
among the older writers on physiology. Although, even at the present day,
our views in relation to the subject are so very imperfect and confused as to
amount to almost entire ignorance; yet of late years it has elicited comparatively
little attention. It still, therefore, remains one of those points in physiology,
upon which the labours of the industrious investigator are calculated to throw
much and important light.
The latest publication in relation to this subject, is the one now before us. It
consists chiefly of the detail of various experiments undertaken with the view
of determining the structure of the placenta, and the mode in which the blood
460 Bibliographical Notices.
is conveyed from the pregnant uterus to the foetus, and from the latter back
ag-ain into the vessels of the mother.
We cannot certainly subscribe to all the views which the author has thrown
out in the course of his remarks, a few of which do not appear to us to be
clearly proved by the result of his experiments. The work is nevertheless
highly interesting-, and deserving- of a careful and candid perusal.
From his experiments, twenty-four in number, M. Biancini conceives the fol-
lowing conclusions to be legitimately deducible.
1. The umbilical arteries communicate with the veins of the maternal uterus.
2. The communication between these two sets of vessels is effected by means
of an intermediate series of large, straight vessels, to which, as they accom-
pany the uiero-placental a.rter\es, and fulfil the office of transporting the blood,
returned from the foetus and placenta, to the vessels of the maternal uterus, the
distinctive name of placento-uterine veins may with propriety be applied.
3. The placento-uterine veins are not to be considered as prolongations of
those of the uterus? they are, in fact, a new formation resulting from the act of
impregnation.
4. The umbilical arteries being continued into the placento-uterine veins,
establish a direct communication between the venous blood of the foetus and
that of the uterus of the mother; while the utero-placental arteries, inosculat-
ing with the radicles of the umbilical vein, cause a similar communication be-
tween the arterial blood of the two.
5. The proper substance of the placenta is composed of ramifications of
blood-vessels and a reticulated tissue, and is made up of the ultimate divisions
and terminations of the vessels which unite the mother with the foetus, and vice
versa.
6. In the placenta there exists two circulations of blood; one, namely, of the
blood proper to its own tissue, and another, of the blood destined for the nou-
rishment of the foetus. There is no difference, however, between these two
portions of blood.
7. The arterial blood supplied from the vessels of the mother is conveyed to
the placenta by the utero-placental arteries, which anastomose with the radicles
of the umbilical vein; which latter performs the office of an artery.
8. One portion of the maternal blood is distributed to the proper tissue of the
placenta, by means of the collateral ramifications of the utero-placental arte-
ries and umbilical vein, and another is conveyed into the body of the foetus by
the principal trunk of the latter vessel. The blood, after being circulated
through the foetus, is returned back again to the placenta by the two umbilical
arteries which perform the office of veins.
9. The blood, finally, returned from the foetus, mixed with the blood return-
ed from the placenta by branches of the umbilical arteries and the placento-
uterine veins, passes immediately into the veins of the maternal uterus, through
the principal trunks of the placento-uterine vessels.
The foregoing views require no comment. The several points in which they
differ from the generally received opinions of modern physiologists will be per-
ceived at once by our readers, all of whom are to be presumed conversant with
the latter. The truth or falsity of M. Biancini's propositions can be determined
only by a series of judicious and cautious experiments. D. F. C.
( 461
QUARTERLY PERISCOPE.
FOREIGN INTELLIGENCE.
ANATOMY.
1. Case of Diverticulum of the (Esophagus. — A merchant, set. 54, during- a
meal, perceived that a mouthful of food, instead of passing on to the stomach,
was arrested at a point in the oesophagus. From this time forward he experi-
enced a sensation of pain whenever deglutition v/as attempted. The affection
went on increasing, until the pain experienced after each repast was excru-
ciating; and he was obliged in order to swallow his food, to cause it to regur-
gitate, and then rechew it, so that he might be said to have become in a degree
a ruminant; a sound introduced into the oesophagus indicated the existence of an
obstacle in this tube, which it was impossible to overcome. xVlthough the pa-
tient swallowed a large quantity of food daily, but a small portion of it passed
into the stomach, the rest being rejected after each repast; a large tumour ap-
peared on each side of the larynx, which could be emptied by pressure, their
contents being discharged partly into the oesophagus, and partly into the sto-
mach. After nine years of suffering the patient at length died, his death being
caused absolutely by hunger and debility.
Autopsy. — Upon dissection the cause of the symptoms manifested during life,
was found to be a large pouch or diverticulum, which started from the oeso-
phagus just below the transverse fibres of the inferior constrictor muscle of the
pharynx. The orifice of the diverticulum did not equal in diameter the cavity
of the oesophagus, but suddenly enlarging, terminated in a pouch three inches
nine lines in length, one inch and three fourths in breadth, and about the size
of a child's fist. The upper portion of the sac reached as high up as the middle
of the thyroid cartilage, whilst the inferior portion extended as low down as the
fourth ring of the trachea. The parietes of the sac were of some thickness,
and composed of three distinct layers. The external one was cellular, ami
covered over with well-developed muscular fibres, which passed from the oeso-
phagus to the diverticulum; the second, (mucous,) was thicker than the mil-
cous membrane of the oesophagus and pharynx, and the third was formed by a
continuation of the epithelium of the oesophagus. The sac when filled with food,
was pushed forward upon the oesophagus, which it closed completely? the re-
sistance offered by the cervical vertebrae to its dilatation posteriorly, being the
chief agent in the production of this state of things. It was this which caused
his death.— Gaz. Med. Sept. 2Uh, 1833, from Rust's Mag. Vol. XXIX.
2, Case of Epispidia. By Dr. Cramer. — In the autumn of 1828, during the
levy of troops in Wesensee, I had an opportunity of examining a young man of
21, who had a remarkable malformation of the urinary organs. The urethra did
not lie in its usual place beneath, but above, the corpus spongiosum, and was
divided in its whole length from the arch of the pub es to its extremity: the
39*
462 QUARTERLY PERISCOPE.
penis was of the natural length. The mons veneris was wanting, but in its stead
there was a reddish skin, covered with a scaly cuticle, and destitute of hair. Be-
neath the pubal arch there was an opening-, into which a finger might be readily
introduced, so as to reach the isthmus. The glans was also divided, and the
rudiments of a prepuce were observable about its root. When the margins of
the fissure were brought together by pressing them on both sides, they were
found to coincide pretty exactly. There was nothing apparently amiss with the
scrotum and testes: and the animal passions were energetic, though the young
man denied that he had ever had any sexual intercourse. His parents were
healthy people, and none of his brothers or sisters ever had any deformity that
he was aware of. It should be added, that this person laboured under inconti-
nence of urine; and for the greater convenience of emptying the bladder, was
in the habit of generally wearing a petticoat instead of breeches. Does not
malformation of this kind belong to the hare-lip and cloven-palate species; and
might it not be cured by similar means? — Med. Gaz. from Hecker's Medici-
nische Zeitung.
3. Congenital Malformation of the Brain. — M. Deschamps communicated to
the Royal Academy of Sciences at their meeting of 2d September last, a de-
scription of a case of this kind, different from any hitherto described. The
subject of it was a man forty-three years of age, who died in one of the Parisian
hospitals in consequence of an injury. The brain presented, 1st, a prolonga-
tion of the fissure of Sylvius to the superior face of the left hemisphere; 2d,
two accidental distinct openings, around which the cerebral convolutions were
folded, openings which established a communication between the periphery of
the brain and the central parts; 3d, a trifid lobular division at the face of the
upper hemispheres. — Archives G^nerales, Sept. 1833.
4. Displacement of the Orifice of the Urethra in a Young Girl. — Dr. Otto has
met with a curious instance of this in a girl labouring under typhus fever, and
in whom paralysis of the bladder supervened. Upon attempting to introduce a
catheter to evacuate the urine, although the fossa which usually leads to the
orifice of the urethra existed, no orifice could be there detected. On further
search the orifice was found at the inferior and interior part of the left labia pu-
dendi. — Heidelberger Klin. Ann.
PHYSIOLOGY.
5. Sympathy between the Uterus and Mammse. — The London Medical Gazette
for March last, contains some observations by Dr. Rigbx on this subject, which
are peculiarly interesting from the practical advantage to be derived from the
play of this sympathy in the suppression of uterine haemorrhage. There is, per-
haps, remarks Dr. R. " nothing more interesting, or more worthy the attention
of an accoucheur, than the various sympathies which show themselves between
the uterus and other parts of the system. The morning sickness of early preg-
nancy; the convulsions in the latter months, or during labour; the violent rigors
when the os uteri becomes fully dilated, or immediately after the birth of the
child; the contraction of the uterus when the face is sprinkled with cold water,
or after a draught of any cold fluid; are some of the most remarkable, among a
considerable number, which occur before and during labour.
" The connexion, in the unimpregnated state, between the uterus and stomach
is well displayed by the gastric derangement which frequently accompanies pro-
lapsus uteri, and vice versa. The pain and swelling of the mammary gland from
menstrual irritation, or where there is subacute or chronic inflammation, or
organic disease of the uterus, in like manner demonstrate the link between this
organ and the breast. But the most striking instance of sympathy which I have
Physiology, 463
remarked between these two organs, is the sudden and powerful contraction
which is excited in the uterus, when in a state of inertia, by applying- the child
to the breast.
** My attention was first drawn to this subject by an observation which I met
with some years ago in Carus's Gynakologie, recommending the application of
the child to the breast to promote expulsion of the placenta where it was slow
in coming away 5 but I was far from being aware of the extent to which this sym-
pathy really existed. In cases where there has been considerable disposition
to haemorrhage after labour, from non-contracted uterus, and where I have been
afraid to leave the patient, lest flooding should come on in my absence, 1 have
been for the last two years in the habit of ordering the child to be put to the
breast as soon as her clothes, &c. were changed, and herself comfortably settled
in bed, feeling that I thus diminished the chances there might be of any hae-
morrhage occurring. It was not, however, till last year that I began to see the
practical importance of this sympathetic connexion between the breast and ute-
rus in its full extent. Having had two or three cases of severe haemorrhage after
labour, from uterine inertia, which had to a degree resisted all the common
modes of treatment, and where permanent contraction could not be induced
even by repeated injections of cold water and vinegar into the vagina, I deter-
mined to see what effect the application of the child to the breast would have
upon the relaxed uterus, and was agreeably surprised to find the observation of
Professor Carus confirmed in its fullest extent, firm and permanent contraction
having been immediately preduced in every case."
" When I first began," Dr. R. adds, " to use this plan of treatment in cases of
inertia uteri after delivery, I was frequently startled by finding a sudden gush of
blood, accompanied by a forcible discharge of coagula, follow almost instantly
the application of the child; but soon satisfied myself, that so far from being a
return of the flooding, it was merely the result of the uterus contracting firmly
and expelling its contents.
** It is a common saying among nurses, that * the child brings after-pains;^
that is, when the child is first applied to the breast on the second or third day,
as was formerly the custom, it was frequently followed by pretty smart after-
pains which evidently resulted from the uterus being excited to contract and
expel any coagula of blood which might be lodging in its cavity or sinuses.
Hence, besides its beneficial effects in preventing any danger from haemorrhage,
the early application of the child to the breast is a valuable means of preventing
much of that uterine pain and irritation which is apt to result from the presence
of coagula, &c. in the womb, after labour.
6. Case of Vagitus UtennuSj before and after ike Rupture of the Membranes.
By Dr. Hetfelder. — Whether it is possible for a child in the womb to breathe
and cry, is a question which has been variously mooted by medical men, but
has never till now been set at resJt. I confess I used always to think that the
cases we have on record of vagitus uterinus previous to the rupture of the mem-
branes, were all fabulous; for it is quite unaccountable how, under such cir-
cumstances, the air necessary for breathing and crying can reach the foetus.
This day however, (the 23d of September, 1833,) my scepticism has been com-
pletely removed by the following case:—
The wife of a dyer, of the name of Holdevied, living in Gorheim, near Seig-
maringen, a stout, well-made, healthy young women, aged 24, was in labour of
her first child. The pains had lasted for 48 hours. On examination I found the
abdomen regularly and firmly distended; the extremities of the foetus were per-
ceptible above the navel, towards the pit of the stomach; the orifice of the ute-
rus was open to the extent of three inches, but the membranes were neither
protruded in the intervals of, nor during the pains, which were not strong nor
frequent. Immediately behind the membranes, however, lay the face of the
child, in which, with my finger, I could distinguish the eyelids, the nose, and
the mouth. So little liquor amnii was there present, that I at first thought there
464 QUARTERLY PERISCOPE.
was nothing- between my finger and the features of the Infant, and that the mem-
branes must have been ruptured previously to my arrival; but upon further ex-
amining the lips, I found the presence of a foreign membrane, which prevented
the entrance of my finger into the mouth: and I should add, that the mouth it-
self, as well as the other parts of the face, lay between the upper and middle
apertures of the pelvis.
While making this observation, and particularly at the moment of touching
the lips, I suddenly heard a noise — it was the cry as of a new-born child begin-
ning to respire. All who were present, the midwife, the husband, and the pa-
tient herself, heard it as well as I did, and testified their great surprise. This
occurred in the short interval between two pains. I now considered it adviseable
to rupture the membranes, and did so, with proper precaution, immediately
over the mouth of the child: some water was discharged, and the same cry which
was already heard was repeated, but it was much more distinct, and continued
longer than before. We heard it also soon after, for the third time, and not
less clearly. The forceps were presently applied, and I succeeded, not without
some little diificulty, in bringing into the world a pretty strong living infant.
Such a presentation as that in the foregoing case, — the parietes of the uterus
not covering nor compressing the child's mouth, — must be peculiarly favourable
for the occurrence of vagitus uterinus — at least after the rupture of the mem-
branes. And it would seem that such a phenomenon can only occur where the
pains are weak, and the contractions of the uterus not considerable. But I shall
not enter into any hypothesis to account for the occurrence of vagitus before the
rupture of the membranes: I would only say, that it seems to be analogous to
the chirping of the chick in the e^^, first noticed by Mende, and too often at-
tested since to be now gainsaid. And might not the deficiency of water be-
tween the membranes and the child's face, together with the peculiar presen-
tation of the latter, have materially favoured the vagitus in the case just re-
lated.— Med. Gaz, from Medicinische Zeitung. of Berlin.
7 . Memoir upon the Structure of the Lymphatic Vessels. Read at the Medical
Society of Emulation of Paris, at its Meeting on the 2d of Octoher^ 1833. By Pro-
fessor MojoK. — Dr. M. former Professor of Anatomy and Physiology at the
Royal University of Genoa, has lately made some new observations upon the
structure of the lymphatic vessels, which appear to be well worthy of the in-
terest of physiologists. Having placed the lymphatic vessels upon a glass plate,
and^opened them through their entire length. Dr. M. has recognised, by the
aid of the microscope, that which anatomists regard as valves or folds of their
internal membrane, are in fact true sphincters. These sphincters are formed
by circular fibres, which, diminishing at different points, the calibre of the
lymphatic tube give rise to those nudosities which are remarked at their exte-
rior. The contractions are still more visible when the lymphatics are injected
with some liquid. They may also be observed very distinctly when this system
is in an almost varicose state, as in subjects who have died with anasarca.
If the two ends of a varicose lymphatic be drawn in a contrary direction,
these external nudosities disappear entirely, as well as the pretended internal
valves.
Professor Mojon has observed, besides, that the fibrous membrane of the lym-
phatics, of which Mascagni has spoken with sufficient exactness, has longitudi-
nal filaments from one contraction to another, much more numerous than the
oblique. This crossing of the fibres forms a tissue like a kind of lattice.
The longitudinal fibres have their two ends attached to the transverse, which
constitute, according to the views of the Genoese anatomist, the sphincters or
contractors of the lymphatics. Thus the longitudinal fibres in contracting,
draw one sphincter nearer to another, whilst the oblique fibres diminish the
diameter. All these fibres, taking their point of support upon the circular
fibres, dilate the superior sphincters by drawing the circumference downwards.
By means of this physico-vital mechanism, the fluid which penetrates a lympha-
Pathology, 465
tic, irritates the portion of the vessel which it fills, which contracting upon
tself, diminishes its cavity, and the fluid there contained is obliged to advance
by thus successively traversing* the open sphincter. This peristaltic motion is
performed inthe same manner as that of the intestines. This vermicular move-
ment may be observed very distinctly in the lacteal vessels of the mesentery of
animals, which are opened two or three hours after they have been well fed.
By admitting this organization of the lymphatics, the retrograde movement
of the fluids contained in the absorbent system, admitted by Darwin and others,
may be explained, which would be incompatible with a valvular apparatus.
If this system of vessels were valvular, why, says Dr. Mojon, when a lympha-
tic is opened in its whole length, does it never present but two parallel crescents
from one space to another, one to the right, the other to the left, and never
one and two halves? That, indeed, would happen often, if these crescents
were true valves, like those of the veins.
The difficulty which is often met with in attempting to inject the lymphatic
vessels in a contrary direction to the fluid, which passes through them, is owing
to this; that the little pouches formed by the sphincters, and the relaxation of
their parietes in filling them with the injecting matter, inflate them, and by that
means close the opening of the lymphatic.
The observation several limes repeated, that the diff'erent coloured fluids
with which the lymphatic vessels are injected, never spread themselves either
in the cellular tissue, or in the parenchyma of the viscera, unless by some lace-
ration, induced M. Mojon to believe that these vessels had no patulous orifice, and
that they took their origin from a cellular filament, which progressively became
a villosity, an areolar spongiole, a capillary, and at length a lymphatic trunk. He
also believes that the absorbent action of this system of vessels is performed by
a kind of imbibition through the porosity of their most delicate branches, like a
sponge. When once the liquid has penetrated by this kind of endosmose into
the cavity of the smallest branches of the lymphatics, it advances into the larger
trunks by a progressive and continued peristaltic motion up to the absorbent
system.
Several French anatomists have lately repeated these experiments; they have
obtained the same results. — Journal de la Societe des Sciences Physiques et Che-
miques, Nov. 1833.
8. Contraction of the Uterus after Death. — Dr. Trustedt relates in Hecker's
Journal^ the following case of this. *' A woman who was under the care of Dr.
Rudolphi died suddenly, at an advanced period of pregnancy, in consequence
of an attack of febris intermittens apoplectica. Her death took place about four
o'clock, P. M. ; in an hour after which, she was removed from the bed and placed
on some straw on the floor, covered with a sheet. A woman left in the room
to watch the corpse, was, about midnight, greatly alarmed by hearing a noise
proceeding from the part of the room where the body lay, and immediately alarm-
ed the house, being persuaded that the deceased was coming to life. On ex-
amination, a full-grown dead child was found between the legs of the mother." — ■
Dublin Medical Journal.
PATHOLOGY.
9. On the Pathology of Typhus Fever. By Professor Bouillaud. — It results,
says M. Bouillaud, from the thirty-six cases of typhoid entero-mesenteritis,
which were lately treated in the wards of the La Charite, that the inflammatory
affection of the lower part of the small intestines, and especially of the clusters
of the glandulse Peyeri, constitutes really and truly the fundamental and essen-
tial element of the disease. In every instance, from the very commencement
466 QUARTERLY PERISCOPE.
of the morbid phenomena, the local symptoms have clearly indicated the ex-
istence of such a phlegmasia; and the typhoid state has been developed under
the influence of the entero-mesenteritis, in the same manner as we see it super-,
vene in certain cases of severe phlegmonous erysipelas, of phlebitis, &c. It
would not be more reasonable to consider inflammation of the intestinal folli-
cles and of the mesenteric glands as a simple consecutive effect of the typhoid
state, than it would be to regard a phlegmonous erysipelas, in the course of
which, typhoid symptoms were developed, as the result of these very symp-
toms. Such a doctrine would be, in truth, a " contre-sens," pathogenesis. We
do not, indeed, deny that erysipelas may occur in subjects already labouring
under typhus fever; all that we contend for is, that the obverse case, viz. where
the erysipelas is formed before the explosion of the typhoid symptoms, is by no
means uncommon, and the scope of our reasoning is obvious when we assert,
that the entero-mesenteric phlegmasia is of an erysipelatous character. To
those who gainsay our doctrines, we confidently challenge them to adduce a
single well-recorded and well-authenticated case of acute inflammation of
Peyer's, and of the mesenteric glands, which did not exhibit in its march and
in its symptoms, local as well as constitutional, a most close analogy, if not a
complete identity, with that disease, which has been most unfortunately desig-
nated by the appellations of fever, typhoid affection, &c. If it be true, as the
Father of Medicine has predicated, that " naturam morborum ostendlt curatlo,"
another very potent argument may be adduced in favour of our pathological
tenets, from the success of the remedial measures we adopt. These are emi-
nently antiphlogistic. It may be said that some of the means, as the quinine
and the chlorurets, (which were used in a few of the cases in the hospital,) are
very far from being so; but who does not perceive that, at the period when we
had recourse to these, the inflammatory affection had assumed what the ancients
denominated a malignant, or rather a putrid character, and, therefore, required
for its arrest the intervention of certain measures, superadded to those of a
strictly antiphlogistic tendency? In the period of the malady to which we are
referring at present, there is indubitably a focus of putrid decomposition, which,
reacting on the whole economy, induces great and important changes in the
mass of the blood and other fluids, and to counteract the effects of which, a
new and paramount indication arises — an indication which is best fulfilled by
the use of the chlorurets, both externally and internally, and of certain tonics,
especially quinine.
How agreeable it is to find out that the doctrines which we have taught and
inculcated for so many years, are in accordance with the experience of some
of the greatest men who have gone before us. The illustrious Sydenham,
whose authority is so often misapplied and abused in the present day, has ad-
mirably pointed out the relations between the phenomena of malignancy or
putridity, and certain sorts or shades of inflammatory action: — " Cujus de
malignitate opinlonls inventio, humano generi longe ipsa pyrri-pulveris inven-
tione laetalior fuit. Cum enim hae febres prsesertim raalignse dicantur, in
quibis intensioris prae cseteris Inflammationis gradus conspicitur." The follow-
ing case will illustrate my treatment of typhus gravior.
A man was brought to the hospital in the second week of typhus fever, and
of such an aggravated character were all the symptoms, that we quite despaired
of saving him. The prostration was extreme — the tongue, lips, and teeth co-
vered with a black crust — breath very fetid — respiration exceedingly feeble —
pulse minute, and very rapid — abdomen distended — slight diarrhoea — surface of
the belly and chest exhibited several reddish patches and papulae, (eruption
typhoide.) The state of this patient positively forbad the employment of any
depletory measures, and the only judicious indication seemed to be, to obviate
the putrid symptoms by the use of the chlorurets in drinks, baths, and enemas.
In three or four days there was a sensible amendment; a blister was applied on
the calf of each leg, and ten grains of the sulphate of quinine sprinkled every
Pathology. 467
day on the excoriated surfaces. The diet was gradually rendered more nourish-
ing-, and consisted of broths, soups, fruits, and weak wine and water. This
patient ultimately recovered.
Let the preceding case satisfy my opponents, that the same treatment is not
uniformly, and to the same extent, followed, in my treatment of fever, without
regard to the character of the symptoms, or to the constitution of the patient.
By a judicious combination of antiphlogistic and antiseptic remedies, thirty-three
cases out of thirty-six, admitted into our wards, were saved. Such success
could not rationally be expected to result from a therapeutics, which inculcated
the use of stimulants, purgatives, and emetics. At the commencement, indeed,
of the malady, a purgative or an emetic may be administered with advantage;
but if they be of drastic severity, or are frequently repeated, the enteritic evil
must necessarily be much aggravated. What confirms me in this opinion is,
that I know that M. Trousseau has lately abandoned the practice of giving ire-
quent doses of Glauber's salt in dothinenteritis, [the entero-mesenteritis ty-
phoide,] as recommended by his master, M. Bretonneau. At present he ap-
pears to be'satisfied with the ''medicine expectante;"for he gives nothing else
but the white oxide of antimony, a substance very nearly quite inert; and yet
he assures us, that his success of late has been very great in the treatment of
cases of genuine typhus. No doubt much good may arise from merely abstain-
ing from every thing positively injurious, and from not interfering with nature's
ovs^n operations; but we think that even the late M. Dance, who was very scep-
tical as to the advantages of the common practice in fevers, could not have
withstood such practical evidence as we have adduced in favour of the plan
which was followed in the thirty-six cases, of which no fewer than thirty-three
recovered. — Journal Hebdomadaire.
10. M. BouiLLAUD on Follicular Enteritis. — The term "foHicular enteritis"
is to be preferred to the one formerly in use, " gastro-enteritis," on account of
its more accurately indicating the nature of the existing lesion; for in many
cases there is no inflammation of the stomach, the disease being limited to the
mucous membrane, and especially the follicular apparatus of the small intes-
tines; and besides, we see every day examples of genuine gastro-enteritis, un-
accompanied with the symptoms of typhus fever. M. Bretonneau has lately
introduced the term '* dothinenteritis," or furuncular enteritis, and, although
we cannot, with strict propriety, admit the furuncular character of the disease
of the intestinal glands, the term is not a bad one. Follicular enteritis has the
same meaning, and is more simple in its enunciation. The bizarre appellation
of "ileo-dicliditis,'^ in allusion to the seat of the disease in the ileum and ileo-
coecal valve, does not at all express the nature of the diseased change, but
rather its mere habitat. M. Bouillaud is in the habit of employing the terms
of adynamic or putrid entero-mesenteritis, and in order to localize the chief
seat of the morbid change, adds occasionally a special, instead of the general
prefix, thus, adynamic ileo-mesenteritis, &c.
Eighteen cases occurred in the service of M. B. at the La Charite, during
the summer months, and of these, fifteen took place in men, and the remain-
ing three in women. This striking difference is, no doubt, attributable to the
more debauched and irregular lives of the former, and also to the circumstance
of far more men coming to Paris, from the country or elsewhere, for subsist-
ence; for, indeed, the greater number of the cases we see here, are in those
who have resided but a short time in the city. Out of our eighteen patients,
eleven had been only four months in Paris — four from six to twelve months —
one fifteen, and another twenty months resident there. They were all under
twenty-eight years of age. The season of the year, viz. during the months of
June, July, and August, is that when the follicular enteritis is usually most fre-
quently seen. It is always a difficult, and often an impossible thing, to trace
the exciting cause of fever to any one specific agent or influence; and we shall
be generally correct, if we enumerate, not one, but several, such as recent ar-
468 QUARTERLY PERISCOPE-
rival from the country, laborious and excessive work, unwholesome and acrid
food, debauchery, exposure to the inclemencies of the weather, depression of
spirits. Sec.
The premonitory symptoms are, a greater or a less prostration, general un-
easiness, anxiety, want of appetite, feeling* of coldness over the surface, thirst,
head-ache, and in many cases, some degree of purging- and nausea, or even
vomiting. The head-ache becomes more and more severe, accompanied with
noises in the ears, appearance of flashes of liglit before the eyes, vertigo, stu-
por, so that questions are answered slowly and with reluctance, and in many
cases with delirium. The features are void of animation, except when inflamed
during the delirious paroxysm; the eyes become considerably sunk, the nose
is sharpened, and the lips are black, and coated with a dark crust. The skin
is always hot and dry — the gentlest perspiration is ever a most favourable symp-
tom; for, in all the worst cases, there is a constant aridity of the surface, and
only towards the latter stage is it bedewed with an offensive sickening mois-
ture. In some cases, there is an eruption on different parts of the body; this
may be either papular, exanthematic, or pustular. A very characteristic symp-
tom of this fever when severe, is the position or decubitus of the patient in
bed — he lies in one attitude, seemingl}^ unconscious of all around him, and if
he moves, it is rather like the rolling of a senseless mass than the voluntary act
of an animate being. Complete coma, convulsions, twitching of the tendons,
6cc, are always very unfavourable signs. The tongue is generally smooth, dry,
and red at the point and along the edges, in the early stage; a filthy, yellow-
coloured, cheesy-looking crust covers it, and in the more severe cases, so com-
pletely parched is it, that it has the appearance of having been broiled. The
lips, teeth, and mouth are invested with a filthy brown or black sordes, and the
breath is offensively disgusting. The thirst is always great — sometimes exces-
sive. The gastric irritation is by no means observed in most cases; thus, in our
eighteen patients, six only experienced vomitings; and except in one case,
there was not any tenderness of the epigastric region when pressed upon.
Pressure on the abdomen, especially over the coecum and ascending colon, pro-
duced pain in ten cases. In fourteen, there was well-marked meteorism, or in-
flation of the bowels; and the degree of this symptom was usually proportionate
to the severity of the case. The involuntary discharge of the urine, especially
if this be muddy, ammoniacal, and fetid, always prognosticates great danger.
The almost uniform coexistence of pulmonary disease deserves our serious no-
tice; in fifteen of our cases there was acute bronchitis, indicated by a dry sibi-
lant, or mucous sibilant rale; in two, severe cynanche existed, and in one a
double pneumonia, which caused the death of the patient. The biliary appa-
ratus was not much affected in the majority of the cases. Four of the patients
died, and the following are the most striking necroscopic appearances found.
Serosity under the membranes of the brain; substance of the brain more
highly injected than usual; consistence nearly normal. The stomach, in all
cases, presented at one or more points arborizations of minute vascularity; the
texture of the mucous lining was generally softened, and thinner than in health.
The duodenum was but little affected. On examining the ileum, there were
found, sometimes even from its very commencement, patches of distinct erup-
tion, or of an intense vascularity, with intermediate portions of healthy surface;
but these phenomena were always more distinct as we approached its lower or
ccEcal extremity; at first, or highest up, the glandule Peyeri and aggregated
follicles were merely swollen and enlarged; then here and there they were
found to be ulcerated, the little ulcers having thickened edges, and the subja-
cent cellular tissue being denuded; as we proceeded lower down, the glandulae
Peyeri became more developed, and around them, the single or isolated folli-
cles were converted into aphthous-like ulcerations, with red, and even bloody
borders; towards the extremity of the ileum, the gut was found to be actually
riddled with these ulcerations, which were surrounded with the soft, pulpy, and
inflamed mucous membrane. In one case, the surface of the ileo-coecal valve,
Pathology. 469
and also of the coecum, exhibited these last described appearances. The me-
senteric glands, adjoining to the diseased portions of intestine, were red, hy-
pertrophied, and softened. Most of the other viscera, as the liver, spleen,
heart, &c. presented more or less ramoUissement of texture, so that they were
easily crushed between the fingers.
As to the treatment^ it was in all cases of an antiphlogistic tendency — mode-
rate, but not repeated venesection; the application of leeches upon the epigas-
tric and coecal regions, (the average number required for each patient was be-
tween sixty and seventy in all, or about sixteen at four different times;) in four
cases, cupping was employed to subdue the bronchitic affection. In nine of
the cases, blisters were used, sometimes to the thighs, at other times to the
calves of the legs. In ten cases, the solutions of the chlorides, (which were
first recommended in 1826^ by M. Bouillaud, as valuable remedies against the
intestinal disease, and the consecutive alteration of the mass of the blood,) were
employed, either by the mouth, or in injections, or lastly, mixed with poultices,
and applied to the abdomen. The bed-clothes also, of the patients w^ere freely
sprinkled with them. — Med. Chirurg. Rev. and Journal Hebdomadaire.
11. On Chronic Gastritis.* [Extracted from Dr. Stokes' Clinical Lectures.} —
Chronic gastritis is an extremely interesting disease, whether we look upon it
with reference to its importance, its frequency, or its Protean character. It is
commonly called dyspepsia, and this term, loose and unlimited in its accepta-
tion, often proves a stumbling block to the student in medicine. Dyspepsia,
you know, means difficult digestion, a circumstance which may depend on many
causes, but perhaps on none more frequently than upon chronic gastritis. In
the great majority of dyspeptic cases, the exciting cause has been over-stimu-
lation of the stomach, either from the constant excess in strong, highly-seasoned
meats, or indulging in the use of exciting liquors. Persons, who feed grossly
and drink deeply, are generally the subjects of dyspepsia; by constantly stimu-
lating the stomach they produce an inflammatory condition of that organ. Long-
continued functional lesion will eventually produce more or less organic disease;
and you wall find, that in most cases of old dyspepsia there is more or less gas-
tritis. But let us go further, and inquire whether those views are borne out by
the ordinary treatment of dyspeptic cases. When you open a book on the prac-
tice of physic, and turn to the article dyspepsia, one of the first things which
strikes you is the vast number of cures for indigestion. The more incurable a
disease is, and the less we know of its treatment, the more numerous is the list
of remedies, and the more empirical is its treatment. Now, the circumstance
of having a great variety of " cures" for a disease, is a strong proof, either that
there is no real remedy for it, or that its nature is very little understood. A pa-
tient afflicted with dyspepsia will generally run through a variety of treatment,
he will be ordered bark by one practitioner, mercury by another, purgatives by
a third, in fact, he will be subjected to every form of treatment. Now, all this
is proof positive that the disease is not sufficiently understood. What does pa-
thology teach in such cases? In almost every instance where patients have died
v/ith symptoms of dyspepsia, pathological anatomy proves the stomach to be in
a state of demonstrable disease. It appears, therefore, that, whether we look to
the uncertainty and vacillations of treatment, or the results of anatomical exa-
mination, the case is still the same; and that, where dyspepsia has been of con-
siderable duration, the chance is that there is more or less of organic disease,
and that, if we prescribe for dyspepsia neglecting this, we are very likely to do
mischief. I do not wish you to believe that every case of dyspepsia is a case of
gastritis. This opinion has brought disgrace on the school of Broussais. His
disciples went too far, for whether the gastric derangement depended on ner-
vous irritation, or anemia, or disease of the liver, or mental emotion, they pre-
scribed leeches and water diet, and thus very often brought on the disease they
* Fov the treatment, see department of Practice of Medicine,
No. XXVIII.— August, 1834. 40
470 QUARTERLY PERISCOPE.
soug-ht to cure. We may have functional disease, independent of structural le-
sion in the stomach, as well as in any other organ; it is no unusual circumstance,
and the practical physician meets with it every day. A great deal of confusion,
however, arises from the similarity of the symptoms. I remember an accom-
plished friend of mine getting into disgrace with one of the members of a board
of examiners on this subject. He was asked to tell the difference between the
symptoms of chronic gastritis and dyspepsia, and in reply stated that he could
not. For this he was nearly rejected, but I believe, on a candid review of the
circumstances, you will agree with me, that he knew more of the matter than
the learned professor. In ninety -nine cases out of a hundred of chronic gastritis
there is no fever, scarcely any thirst, often no fixed local pain, and this leads
persons away from an idea of the existence of an inflammatory condition of the
stomach. What are the symptoms of a chronic gastritis? pain of occasional oc-
currence, flatulence, acidity, swelling of the stomach, foetid eructations, sen-
sation of heat and weight about the epigastrium, and perhaps vomiting. Well,
these are also the symptoms of dyspepsia, whether it be accompanied by inflam-
mation or not. How then, when called to a case of this kind, are you to de-
termine the point? I must mention to you here, that it is often hard to do this
with certainty. There are two circumstances, however, which you should
always bear in mind, as they will afford you considerable assistance in coming
to a correct diagnosis; firsts the length of time which the disease has lasted; se-
condly, the result of the treatment which has been employed. You will find,
that where the disease is a chronic gastritis, that it has been of some duration,
that it has come on in an insidious manner, and that it has been exasperated by
the ordinary treatment of dyspepsia. Many persons think, that if you give a
patient medicine, without regulating his diet or issuing a prohibition against full
meals, that you can cure him, and that, as he has no fever, and can go about
his usual business, there is no necessity for antiphlogistic regimen. But as the
disease goes on, he complains of pain in the stomach during the process of di-
gestion, feels uneasy after dinner, there is an unpleasant degree of fullness about
the epigastrium, he also experiences a variety of disagreeable symptoms, some-
times being annoyed with pain in the chest, sometimes he says he feels it in the
region of the heart, and sometimes about the cartilages of the eighth and ninth
ribs. These symptoms subside after the process of digestion is completed, but
during its continuance they harass the patient. Very often relief is obtained by
vomiting, and hence some persons are in the habit of throwing up their food
for the purpose of relieving themselves, and consequently can have no benefit
by it. In some cases digestion goes on until the food seems to reach a particu-
lar point, and then an acute feeling of pain is experienced. In these cases the
gastritis is generally circumscribed, and is likely to terminate in circumscribed
ulceration. Various fluids are rejected from the stomach, during the course of
a gastritis; sometimes acid, sometimes alkaline, sometimes insipid and sweet,
sometimes bitter and bilious. There is generally a degree of fullness about the
stomach, and the epigastrium is tender on pressure, but no decided tumour
either of the pylorus, liver, or spleen, although the epigastrium presented that
appearance of fullness and tension termed by the French *'rem7ewce." The
bowels, too, are constipated, and this is a matter worthy of your attention, for
it sometimes unfortunately happens that the practitioner, mistaking the gastri-
tis for simple constipation, goes on prescribing purgative after purgative, until
the patient gets incurable disease of the stomach. I know a case of a lady
who gets one stool a week by taking eight drops of croton oil. Some years
ago, she was in the enjoyment of excellent health; her bowels happened to get
confined, and she was treated by a systematic practitioner with continued pur-
gatives; her bowels are now completely torpid, except when they are subject-
ed to this unnatural stimulus. There are thousands of persons treated in this
way, because practitioners look to consequences and not to causes.
There is one remarkable difference between acute and chronic gastritis,
which deserves your attentive consideration, as it exemplifies a law applicable
Pathology. 471
to all viscera under similar circumstances, and this is, that the sympathetic irri-
tations are not so frequent or so distinct in chronic inflammation as in the acute
form, and hence, in a case of chronic gastritis, we almost never have fever, and
the affections of the nervous respiratory or circulating- systems are by no means
so well marked. It may even go on to actual disorganization of the stomach,
and yet the patient will not complain of any particular symptom during its
whole progress, which you could set down as depending exclusively on the
sympathetic irritation of gastritis. Some of these cases, called dyspeptic phthisis,
by Dr. W. Philip, are most propably examples of the sympathetic irritation of
the lungs from chronic gastritis. Another case, respecting which much error
prevails, is what has been called hypochondriasis. Persons labouring under
these affections are condemned to run the gauntlet of every mode of treatment,
sometimes (and fortunately for themselves) they are sent to travel, sometimes
they are treated with musk and antispasmodics, then with the mineral acids,
then with purgatives and mercurials, and lastly with bark, nitrate of silver, and
stimulants. They go about hke spectres from one practitioner to another, try-
ing remedy after remedy, alternately sanguine with hope or saddened by dis-
appointment, until at last they die, and, to the astonishment of all the doctors,
the only disease found, on dissection, is inflammation and thickening of the mu-
cous surface of the stomach. A condition, which, under these circumstances, it
was difficult to say whether it was the original disease, or produced by ^^ fair
trials" of a number of powerful agents. Hypochondriasis is not always gastritis;
but it is now found, that in many cases it commences and terminates with dis-
ease in the upper portion of the digestive tube and the assisting viscera. This
you must always bear in mind.
Chronic gastritis terminates in various ways. Sometimes the inflammation is
limited to a particular spot of the stomach, and here we frequently discover cir-
cumscribed ulcerations. In very bad cases these ulcers go on perforating the
various coats of the stomach, until at last the contents of that organ escape into
the serous cavity of the abdomen, and the patient rapidly sinks under a fatal
peritonitis. It does not follow, however, that, in all cases of perforation, the
contents of the stomach get into the perineum, causing death. Very often ad-
hesions are formed, and the base of the ulcer is the serous covering of some
other portion of the digestive system, or a false passage may be formed into the
colon. One of the most common terminations of a chronic gastritis is, that the
inflammation extends to other viscera; the patient gets disease of the liver,
spleen, peritoneum, or lungs, and sinks under a comphcation of disorders. It
was somewhat in this way that Napoleon died. He laboured for a considerable
time under chronic disease of the stomach, which seems to have been overlook-
ed by his medical attendants, and this terminated in the extension of disease to
various other organs. — Lond. Med. and Surg. Journ. Jan, 25th, 1834.
12. Spontaneous Perforations of the (Esophagus and Trachea. By Dr. Aibers,
of Bonn. — These perforations may be arranged under several heads. Under
the first may be comprised all those which commence in the pharynx, and
finally ulcerate the parietes of the larynx or trachea. Dr. Albers adduces three
cases of this description; two from Monro and Sandifort, and one from his own
practice. The first symptom, and that which predominates at the commence-
ment of the disease, is an extreme difficulty of deglutition. In one case the
patient was obliged to push food into the oesophagus with a small stick; never-
theless it often happens that the ulcerated surface is so sensible, that the intro-
duction of any foreign body whatever, instantly excites spasmodic contractions
of the oesophagus, and the instantaneous expulsion of the food by the mouth
and nostrils. Angina pharyngea always complicates these ulcerations of the
oesophagus. It exists in all cases, and the constancy of this symptom gives it
considerable value. At the same time there is excessive secretion of mucus,
the patient experiences a continual desire to swallow, and the glands of the
neck are singularly tumefied; there is usually no pain, except during the act of
472 . QUARTERLY PERISCOPE.
deglutition. All these symptoms appertain to simple ulcerations of the oesopha-
gus; but from the moment that this canal communicates with the trachea by a
fistulous opening-, there is cough, which daily becomes worse, impeded respi-
ration, &c. The patient soon emaciates; swallowing- becomes more and
more difficult; the food is rejected with violent coughing, and the patient
finally succumbs, often after three or four years, sometimes after a much longer
period. In a single case, death occurred at the end of a year and a half.
The second species of ulceration is that which commences in the air-pas-
sages, and which perforates the alimentary canal. This is infinitely rarer than
the first, and also differs from it in the rapidity of its march, and the violence
of its symptoms. Those indicative of an affection of the larynx, give the first
alarm. The alteration of voice, cough, and mucous expectoration, are at first
moderate, especially when the ulceration is not seated exactly in the vocal
organ. But the expectoration soon becomes purulent or bloody, swallowing
painful, and subsequently the food is violently rejected the moment they come
in contact with the part of the oesophagus corresponding to the part of the
trachea which is the seat of disease. By the efforts to cough, purulent matter,
striated with blood, and sometimes pure blood is expectorated. During or
after these efforts, half-digested substances are vomited up by the patient,
whose strength rapidly diminishes, and he dies asphyxiated by food, which
finds entrance into the trachea. Baillie positively denies the occurrence of this
mode of perforation; nevertheless we find in a dissertation by Dr. Kunze, en-
titled De Dysphagia Commentatio Fathologka, 1 820, some examples, in which
the observation of the symptoms, as well as that of the pathological relations,
have proved that the air-passages were the primary seat of the disease.
Finally, there exists a third species of perforation, produced by a tumour of
some kind opening both into the trachea and oesophagus. Dr. Albers reports
two cases from his own practice of this species. The tumours may be of dif-
ferent natures. Sometimes they consist of new formations of fibrous masses,
of cancers, sometimes simple abscesses situated between the oesophagus and
trachea. The commencement of tumours of the first species are not ordinarily
announced by any very striking symptoms. There is difficulty in swallowing,
cough, and all the symptoms of compression of the trachea and oesophagus; but
in proportion as the tumour increases, the compression becomes greater, cough
and vomiting come on, and the patient perishes from consumption, or by hae-
morrhages from the surface of the tumour, which sometimes fill the bronchi
and trachea.
Abscesses are seated in the cellular tissue, uniting the oesophagus to the
trachea, and they are sometimes developed with great rapidity. The great
quantity of pus expectorated is the characteristic symptom of this abscess
having opened into the trachea; the anterior symptoms are the same as those
from other tumours. — Rev. Med. Aug. 1833, from Graefe und Walther^s Jour-
nal, S. 1. 1833.
13. On the Mechanism of the Production of Pulmonary Emphysema^ and on
some of the Effects of Chronic Bronchial Inflammation. By Datid Cbaigie,
M. D. — Ever since the publication of the work of Laennec, in which this va-
riety of lesion received a distinct place and consideration, it has been too much
the practice for teachers to represent, and students to regard, pulmonary em-
physema as a primary lesion, and thereby to overlook entirely its true charac-
ter, and its anatomico-pathological relations. Every case almost of dyspncea,
and almost all cases of what are commonly called asthma, have been since that
time attributed to emphysema of the lungs; while the formation of emphysema,
and the mechanism of its production have been very much, if not entirely
overlooked. I have long and repeatedly had occasion to observe, and to im-
press on the hospital pupils, the fact, that emphysema is one only of many ef-
fects of the chronic form of bronchitis, and that it is only at a particular stage of
the latter affection that the emphysematous distention takes place.
Pathology. 473
In the early stage, indeed, of hronchitist there is simply a diffuse or spreading
inflammation or congestion of the pulmonary mucous membrane, and after it
has subsided under proper treatment, that membrane, both where it lines the
bronchial tubes and pulmonary vesicles, sooner or later returns to its natural
condition; while the calibre of these tubes, and the capacity of the vesicles is
little or not at all lessened. Either, however, after repeated attacks, or long
continuance of this disease, not only does the inflammatory process extend
from the mucous membrane to the submucous or pulmonary filamentous tissue,
but by its long endurance it renders the former thick, villous, and brownish-
coloured, secreting either much viscid mucus, or mucus more or less tinged with
blood, or even occasionally pure blood, and indurates and solidifies the latter
by the extravasation of albuminous fluid; while the increased thickness of the
membrane, and the swelhng of the submucous tissue, encroach so much upon
the area of the bronchial tubes and vesicles, as to diminish remarkably the ca-
pacity of these cavities.
This swelling, however, of the pulmonary mucous membrane and filamentous
tissue is not general over the whole of the tubes, nor even over the whole of
one tube, otherwise it would produce fatal asphyxia. But it in general takes
place at certain spots in the course of the tubes more remarkably than at others,
producing a species of stricture of one or more bronchial tubes in one or both
lungs. The eff^ect of this again is various, according to its degree, and accord-
ing to the component systems and textures of the lung most affected. One of
the most frequent effects of the presence of one of these constricted portions,
especially if the membrane secretes much viscid mucus which requires to be
frequently coughed up, is to obstruct the passage so much that expiration be-
comes either inadequate or is interrupted. As respiration consists, therefore,
in alternate inspiration and expiration, if air has been either inhaled by this tube,
or by some of the communicating ones, it cannot, during ordinary expiration,
be easily expelled. The effect is, that the bronchial membrane and pulmonary
vesicles are excited by their physiological properties to frequently repeated ex-
piratory efforts; and as these are inadequate to expel the air from the lungs,
the compression of the expiratory muscles necessarily, by forcing the portion
of lung into smaller compass, compresses the air already contained in the vesi-
cles beyond the constricted point. The air thus confined, afler many repeated
expiratory efforts, forces its way, by its own elasticity, through the delicate mu-
cous membrane of the vesicles into the pulmonic filamentous tissue, and, when
once there, it continues to spread rapidly in proportion to the obstruction in
the bronchial tubes, and the difficulty of producing* efficient expiration. It is
then that the air contained in these vesicles renders the chest, when struck,
preternaturally resonant; while the extreme difficulty of breathing, with the
dry sonorous rhonchus or sibilism, indicate the laborious struggle which is made
in the tubes, contracted by swelling*, and obstructed, as they are, by adherent
mucus, — to inspire and to expire in an efficient manner.
In this manner, therefore, bronchial inflammation, either by continuance or
repeated attacks, tends to produce emphysema and its usual phenomena; and
there are few cases of emphysematous distention of the pulmonic filamentous
tissue which may not be traced to this cause. In the young, when labouring
under hooping-cough, in the aged, after frequently repeated attacks of catarrh,
and in the middle-aged after the continuance of bronchial inflammation, in a
sub-acute or chronic state, emphysema is with equal certainty, and in equal per--
fection, produced. In the first case, indeed, as the bronchial symptoms subside,
the tubes become more pervious, and expiration becomes so much freer and
less interrupted, that the air ceases to be urged through the vesicular membrane,
and that which had been already impelled into the pulmonic filamentous tissue
is at length absorbed. But in the two latter instances, in which the thickening
of the membrane either abates little, or continues unchanged, the emphysema-
tous distention continues to increase, until it has attained an extent almost in-
credible to those unaccustomed to examine cases of chronic bronchial disease.
40*
474 QUARTERLY PERISCOPE.
Emphysemat however, is not the only effect of this state of the bronchial
tubes. The impracticabihty of inspiring and expiring completely in such a state
of the lungs, which implies the absence of the most essential condition of respi-
ration, viz. the frequent and incessant change of air in the bronchial tubes and
vesicles of the lungs, interferes with the necessary changes in the blood of the
pulmonary artery and veins, which, therefore, passes from the former vessel
into the latter, much less completely aerated than it would be in the healthy
state. In addition to this, as the motion of the blood through the pulmonary
artery into the pulmonary veins is always more free, in proportion as the ex-
pansion of the lung by inspiration, and its collapse by expiration, is extensive;
and as both the obstruction of the bronchial tubes by viscid mucus, and the
swelled and congested state of the bronchial membrane and submucous tissue,
prevent the branches of the artery and veins from freely expanding themselves,
the motion of the blood through this order of vessels begins to be interrupted
and retarded, and thus to induce a congested state of the whole pulmonary sys-
tem, which not only adds to the dyspnoea and orthopnoea of such patients, but
eventually terminates in dropsical effusion into the pulmonic filamentous tissue,
into the cavity of the pleura, and even into the general cellular membrane.
The pulmonic filamentous tissue is in general the first seat of this dropsical in-
filtration; and it is one of the most common changes recognised in inspecting
the lungs of persons cut off by long-continued bronchial inflammation.
Chronic bronchial inflammations, further, by its influence in impeding respi-
ration and the circulation of the pulmonary artery and veins, has an indirect
tendency to induce disease of the heart. In consequence of the difficulty which
the blood encounters in passing through the branches of the pulmonary artery,
the trunk of that vessel becomes permanently distended; and the right ventri-
cle, being also distended and incessantly excited to new contractions, becomes
affected with hypertrophy, sometimes with dilatation, sometimes without; and
in other cases it may be merely enlarged with extenuation of its walls. It is, I
conceive, in consequence of the union of the two ventricles in the human sub-
ject,, that this excessive distention and inordinate action, by being first confined
to the right ventricle, gives rise to a similar inordinate action in the left ven-
tricle, that the latter is often found in a state of hypertrophy in persons who
have long laboured under chronic bronchial disease. The fact of the connexion
is at least well established; and the wards presented few instances of bronchial
disease in which the heart was not affected, and in most of the cases of disease
of the heart, the bronchial membrane and pulmonic tissue had been previously
affected. — Edin. Med. and Surg. Journ. Jan. 1834.
14. Death Caused hy the Opening hy Ulceration of a Blood-vessel in the Sto-
mach.— An instance of this has been communicated to the Anatomical Society
of Paris by M. Monestieb. The subject of the case was a man, seventy-eight
years of age. On dissection, at the base of an ulcer, situated near the cardiac
orifice of the stomach, an open vessel was discovered. A large quantity of co-
agulated blood was found in the stomach, and through the whole extent of the
intestinal C2ia'd\.— 'Archives Gen^rales, Jan. 1834.
15. Vaccination. — Two children were vaccinated by M. Brachet of Lyons.
Ten days afterwards there being no appearance of the development of the vac-
cine disease, M. B. re-vaccinated these children. The day after this second vac-
cination, the punctures first made became inflamed, and the disease subse-
quently went through its regular course. The punctures made in the second
vaccination dried and disappeared. — Rev. Med. August, 1833.
16. Re-Vaccination of the Prussian Army. — A circular, dated Berlin, March
15th, 1833, signed by — Vos: Wiebel, Chief of the Military Medical Staff, declaring
that as the results of the re-vaccination of the army, as already affected, fully
proves its necessity, it appearing that, in the guards alone, 1425 out of 2641 exhi-
Pathology. 475
bited the true vaccine pustule, the order, therefore, for re-vaccinating all recruits
is made absolute, and the physician-in-chief of every division is required to procure
and collect from all the several regimental surgeons, correct lists of all the men
who have been re-vaccinated, as well as every circumstance coming under their
observation, connected with the small-pox, and to report the same every year,
at the end of February, to the Royal Military Council. This is followed by a
statement, entitled '* Collection of the reported results of re-vaccinating the armyP
Whereas a number of individuals have been attacked with small-pox, and some
have died in consequence, notwithstanding that strongly-marked scars unques-
tionably proved their having been vaccinated at an early age, it is, nevertheless
apparent that, in advanced years, they still are hable to be infected; and that
such is likely to be the age at which they can be admitted to military ser-
vice. Hence, on the representation of this fact, by the chief staff physician, to
the commander-in-chief of the army, an order was despatched, on the 26th of
March, 1831, to all the medical officers of the army, for the re-vaccination of all
the men who may appear to be possibly liable to suffer; as well as all recruits
whatsoever, whether they have marks of previous vaccination or not. This or-
der was attended to by the several corps which it reached, as far as could be
effected, and with the following results. In the 3d corps of the army, being at
Erfurt, in 1831, where the small-pox was raging, the 24th regiment of Infantry,
and the Fusileers of the 20th, were re-vaccinated, and, out of 6020 men, 2354
exhibited pustules; among which more than one-eighth proved of the true vac-
cine character. In the 8th corps, 2784 were vaccinated, and 925 took; among
which, also, about one-eighth proved true vaccine.
In 1832, 3942 of the 3d corps were vaccinated, and 1594 exhibited effects;
but, as in the rest, somewhat more than one-eighth were true vaccine: in the 5th
corps, of 3234 vaccinated, 2535 were affected in the aforesaid proportion. As yet,
there are no accounts of the other divisions of the army, to which, however, the
order has been sent and executed; the royal military chief being desirous that the
whole army shall be placed in safety on this head. There being great doubts
of the extent of this prophylactic measure, either from the possible failure of
the original vaccination, or from the effect wearing out by time; at all events
enough is established to prove the necessity of the measure; and it is notorious
that, after the re-vaccination of the doubtful men, and the new recruits of the
Fusileer Battalion, at Erfurt, not one became infected, although closely in con-
tact with very many violent cases of the disease. The circular goes on to direct that
a constant attention be paid to the re-vaccination of the recruits, and gives
some minute military regulations for the purpose, demanding a regular return
to be made as before mentioned, after the following manner: — 1, name of the
regiment; 2, place; 3, name of the men; 4, number; 5, if marked by previous
vaccination (a) certain (6) uncertain (c) none; 6, the re-vaccination (a) regular
effect, number (6) irregular, number (c) without effect, number; 7, repetition
on those which failed, (a) with effect {b) without; 8, number of pustules going
through their course; 9, account of cases occurring during the year, in spite of
vaccination, («) varicella (h) varioloid (c) small-pox; 10, general remarks. —
hane^s Monthly Archives from Must's Magazin.
17. Re-vaccination. — The question of re-vaccination continues still to occupy
much of the attention of physicians of France, not only in the capital, but in all
the provincial towns of note. The Academy of Medicine has appointed a com-
mittee to examine all the doubtful points connected with the subject, before
giving any decided judgment, and, from time to time, various communications
are addressed to that body from practitioners residing in the provinces. Amongst
the latter, M. Lt:rott, a physician residing at Bischwiller, has made several
experiments, the results of which possess interest. Within a period of four
years this physician has practised no less than 3600 vaccinations; and in
the year 1832, when an epidemic variola attacked the canton, he had occasion
to repeat the operation on several individuals — eighty-six persons of both sexes.
i
476 QUARTERLY PERISCOPE.
who had all been vaccinated during infancy, presenting" themselves for a second
vaccination. With the exception of one or two, their arms were marked with
the vaccine cicatrix in a perfect form. The following- table gives the results of
the operation, which was performed by introducing the matter through seven
or eight punctures on one arm only: —
Perfect Incomplete False
Eruption. Eiuptioii. ditto.
Individuals re-vaccinated below 10 years of age.. 12 . . 0 . . 5 .. 7
Froml0to20 36 .. 5 .. 12 .. 19
From20to30 32 .. 5 .. 12 .. 15
From 30 to 40 6 .. 2 .. 2 .. 2
The first column of this table, (^perfect eruption,J embraces all the indivi-
duals in whom the pustules were developed three or four days after the opera-
tion had been performed, assuming the true character of the vaccine pustule,
and following the same march, with this sole difference, that the duration of the
secondary eruption was sometimes two days less than that of a true primary one.
The formation of the pustules was always attended by a secondary fever, and
they did not fail to leave a well-marked cicatrix behind them. The second
column, f incomplete vaccine, J embraces those in whom the punctures were co-
vered with pustules on the second or third day; but these always assumed an
irregular form, terminated in a sharp elevated point, were filled with a dirty
yellow serum, and faded on the sixth or seventh day, without being attended
by fever, or leaving any trace on the arm. It is unnecessary to recur to the
third column, as it gives only negative results.
Thus, from the preceding tabic, it clearly follows, that of eighty-six indivi-
duals who were re-vaccinated, twelve presented examples of a second eruption,
so normal and perfect, that it was impossible to distinguish it from a true pri-
mary vaccine. Perhaps it may be here objected, that the first vaccination was
imperfect and ill-done; but M. Lurott affirms, that two-thirds of these patients,
at least, presented vaccine cicatrices so deep and well defined, as to leave no
doubt of the efficacy of the primary operation, and we are entitled to conclude
with him that these individuals exhibited examples of two distinct and perfect
eruptions of vacciola.
As to the interval of time which elapsed between the two operations, and the
results which follow from this portion of the table, M. Lurott observes, 1st, that
before the age of ten years re-vaccination has never, in his hands, produced
any thing but a false vaccine; he has never been able to develope a true and
complete eruption when the interval between the two operations was so short;
2d, that above the age of ten years re-vaccination has, in a certain number of
cases, completely succeeded. The proportion of cases in which the operation
gave rise to a second eruption, seems in direct ratio with the interval which,
elapses between the first and second vaccinations; the longer the interval, the
greater the chance of success. Thus, in some cases, the first vaccination which
w^e perform, although perfectly v/ell done, has only a preservative effect of a
temporary nature, and is limited to a certain number of years. This seems to be
the true solution of the question: but what is that limit? Here our answer
cannot be so precise, for it varies according to individual constitution, but from
the experiments of M. Lurott, the effect would seem to last for at least ten or
twelve years after the first vaccination; but this is a subject which requires a
vast number of experiments in different seasons and countries, before we can
hope to arrive even at an approximate resolution.
A question proposed by the Academy, and which has not yet been satisfac-
torily answered, has also been investigated by M. Lurott, though in a limited
manner, viz. Will the vaccine matter taken from the pustule of a secondary erup-
tion produce a true primary vacciola? The author answers in the affirmative,
on the faith of some experiments, one of which we quote, as it seems very de-
cisive:—
Mademoiselle Bourguignon, nineteen years of age, who had been vaccinated
Pathology. 477
for the first time at the age of seven months, the traces of which were exceed-
ingly well marked on both arms, was re-vaccinated in November, 1832. On
the seventh day after the eruption, the left arm exhibited pustules of a com-
plete eruption, a few drops of matter were extracted from these, and a portion
was introduced on the same day into the right arm of a healthy child, four
years of age. Six punctures were made. A quantity of virus taken from another
child, who had been vaccinated for the first time, was introduced into the left
arm of the same infant by an equal number of punctures. The boy, thus vacci-
nated in both arms, was brought to M. Lurott for examination on the seventh
day. The vaccine pustules were equally perfect on both sides, but they were
not quite so well developed on the right arm. The progress of the eruption,
for both was exactly the same, and the cicatrices which remained, were as deep
on one arm as on the other. The virus collected separately from both sets of
pustules was afterwards inoculated into different individuals, and gave similar
results.
From this and several other facts, which we may have occasion hereafter to
lay before our readers, we are entitled to conclude that re- vaccination furnishes
a matter as efficacious as that produced by a primary vaccination; indeed we
have the analogy of small-pox to support this fact, for experience too often
shows, that a varioloid may give rise to the development of a confluent small-
pox, whether the individual be vaccinated or no. There is some foundation,
therefore, for the opinion which begins to prevail among the public, that the
preservative effect of vaccination is only temporary, at least in a certain number
of individuals; but this, unfortunately, does not diminish its value as a prophy-
lactic, for we have it in our power to repeat the operation whenever circum-
stances may seem to require it.
Were the statistical account of small-pox cases preserved by physicians on an
extensive scale, we should soon have data enough to draw some certain con-
clusions, but this is not the case, especially in England, where questions of
pubhc health, (unless they happen at the same time to affect commercial inter-
ests,) are totally neglected by the government, and left to individual zeal or
taste for investigation. The canton of Bischwiller comprises about 25,000 in-
habitants, and of these the greater part has been from time to time vaccinated
by physicians appointed under the government; the non-vaccinated may amount,
perhaps, to one-thirtieth of the whole population. In 1832-3, small-pox broke
out in this district, and attacked 439 individuals, of whom 93 were not vaccinat-
ed, and 346 were. If we examine these 439 patients with regard to their age,
we find that 103 were less than ten years of age; 146 from ten to twenty; 156
from twenty to thirty; 34 from thirty to forty, &c.
The result to be drawn from this comparative statement of ages is interesting
and instructive. In the first place we may remark, that the class embracing chil-
dren below ten years of age, is the most numerous in a population, and con-
tains the greater number of non-vaccinated individuals; yet the amount of pa-
tients in this class is one-third less than for the two following. Whence this
difference? The answer must be drawn from the modifying effects of time on
the preservative power of vaccination. During the eight or ten years which
succeed the first vaccination, the preservative effect of the matter is most com-
plete, and gradually looses its influence with succeeding years. After the age
of thirty or thirty-five, the number of patients was comparatively insignificant,
because after this age the disposition to contract small-pox is very feeble, and
hence re-vaccination is not so necessary for those advanced a little in life, as for
the young or adults. — Lancet.
18. Ulcerations of the Intestines cicatrized. — M. Sedillot exhibited to the
Anatomical Society of Paris, at their meeting of the 8th of August last, a por-
tion of the intestine of an individual affected with dothinenteritis, from which
he was convalescent, when he died from abscess of the elbow. Some of the
plates of Peyer were perfectly cicatrized, and others partly soj in some places
478 QUARTERLY PERISCOPE.
the cicatrice reposed upon the serous tissue itself, the plates being entirely de-
stroyed.—i2eu. Med. Oct. 1833.
19. Note of a Case in which Thirteen Ounces of Cerebro- Spinal Liquid was
Found. By M. Montault. — The subject of this case was a man sixty-eig-ht years
of age, who had always enjoyed good health. The 12th of June becoming in-
toxicated, as was habitual, he became delirious, with difficulty of moving. When
he was admitted at the Hotel-Dieu some days after, he was able to move all his
limbs, but with httle energy; his tongue was covered with a very thick, brown-
ish crust; he had not entirely lost his faculties, but he gave a bad account of what
he had felt; he was said to have a cerebral affection, the nature of which was
not discovered, and he died the 19th, after having remained twenty-four hours
in a comatose state. At the autopsy the only thing that was found to be wrong
was that there were twelve ounces, seven drachms and a half of cerebral spinal
liquid, and the membranes with which the liquid was in contact, were of a dull
white colour and infihrated. We do not know if it be proper to attach much
importance to this anomalous quantity of cerebral spinal liquid. In a habitually
healthy state, it appears that the quantity of this fluid varies from six to seven
ounces in old men. The diff^erence then is not as great as it would be at first
thought, nevertheless it is a fact to be remarked, and perhaps some cases may
be found resembling it. — Journ. Hehdom. M.ugust, 1833.
20. New Theory of the Formation of Tubercles. — At a late meeting of the
Academy of Medicine, M. Breschet read an interesting report on this subject,
of which the following is a resume.
Various opinions have been promulgated on the formation of tubercles. Some
regard them as products of inflammation; by others they are attributed to a
peculiar action, which is not inflammatory; and some physicians refer the origin
of tubercles to parasitical animals of the family called by M. Bory St. Vincent,
psychodiaires.
M. Kuhn, of Niederbroun, adopts this latter opinion. According to him, tu-
bercles are originally nothing but acephalocysts, and tuberculization, a name in-
vented expressly, is the result of the destruction of these animals. The author
of the present paper has chiefly studied the development of tubercles in the
lungs, and employed for that purpose a microscope, magnifying nine or twelve
times. When you extract with precaution one of those small granulations, of a
gray colour, which abound in the lungs of certain individuals, and are the origin
of tubercles, and place it under the focus of the microscope, having lacerated
it, you see that it is composed of other granulations still smaller; and the lace-
rated substance seems to be composed of an innumerable number of small al-
buminous globules, connected to another by hyaline filaments, and the whole
enveloped by a layer of mucus. Granulations, therefore, appear to be consti-
tuted by a filamentous apparatus, surrounded by globules in great number. The
analogy is clear and striking between this structure and that of the mould which
forms on paste, bread, &c.
This analogy, without doubt, does not amount to a demonstration; however,
the ideas of the author, (says M. Breschet,) deserve peculiar attention; they
point out the way to a new theory, and to the probable existence of a new class
of beings which has not hitherto been suspected. When we examine the gra-
nulations with care, we find a great number which become opaque in different
points; others are already half opaque; finally, some have become perfectly
opaque in their whole extent.
These observations afford a strong argument against individuals who regard
the granulations as totally foreign to the production of tubercles. Tuberculiza-
tion commences in the centre of the granulation, and extends from the centre
to the circumference. It is eff*ected by the absorption of the mucous surround-
ing the granulation, which is converted into a substance composed simply of the
globules and hyaline filaments. The tuberculization goes on more readily in
Pathology, 479
certain individuals than in others, and may go on to such a degree as to obstruct
the lungs altogether, and produce death before the tubercles are perfectly
formed. M. Kuhn has also examined, with the microscope, the expectorations
of phthisical individuals. When the globules which float in the more liquid
matter were separated, he found them equally composed of hyaline filaments,
and of small viscid globes surrounded with mucous; thus there is a striking re-
semblance between the globules found in the spittle, and the gray granulations
disseminated through the lungs.
From these several facts the author concludes: — 1st. That pulmonary granula-
tions are composed of globules and hyaline filaments, clothed with mucus. 2d.
That they are analogous to parasitical animals found in other substances. 3d.
That they may be converted into tubercles, although this change is not always
•necessary. 4th. That tuberculation is effected by the absorption of the mucus,
and finally, that we find the elements of these granulations in the expectorated
matter. — Lancet, May 10th, 1834.
21. On the Means of Preventing Scarlatina. [Extracted from a Memoir pre-
sented to the Royal Academy of Medicine. By M. Miguel, M. D.] — Being con-
vinced of the ineflnicacy of the hygienic and therapeutic means hitherto employ-
ed against the propagation of the scarlatina, the author of the present memoir
was induced to make several experiments, from which he thinks himself justi-
fied in concluding " that the scarlatina, like many other analogous diseases,
may be inoculated so as to determine a local inflammation which has little re-
action on the economy, but is preservative in the same manner as the vaccine
virus is against small-pox." As a preliminarv measure the author made numer-
ous experiments with the vaccine and variolic matter on adults and children,
from which he deduces the following proposition, viz.: — that it is possible to
localize often, if not always, those eruptive diseases which are capable of being
inoculated, and that individuals subject to be affected are preserved by this
process from subsequent danger of contracting the disease. Since, then, the
scarlatina may be inoculated, why should it not follow the same laws as variola,
&c. and be localized like them, with a preservative influence on the constitu-
tion? This was a theory worthy of investigation. M. Miguel therefore was de-
sirous to put it to the proof, and in November, 1833, an epidemic attack of
scarlatina, which broke out at Nazelly, afforded him an opportunity of making
the following experiments.
Experiment 1. — A young girl, the child of Dennis Carron, fifteen years of age,
presented an example of scarlatina in the most unequivocal form. On the fourth
day of the eruption the author pricked several papulae with four lancets. The
incisions did not bleed, but a yellow matter was discharged, and adhered to
the point of the instrument. This was carefully preserved, and the author im-
mediately proceeded to the house of a nurse, where several children from the
Madeleine of Tours had been placed. Several slight incisions were here made
in the arm of an infant twenty-seven or twenty-eight months old, and the mat-
ter contained on the points of the lancets was introduced. On the following
evening, that is, thirty hours after, the incisions began to exhibit a blush of red-
ness. On the second day the redness was well marked, and continued to in-
crease in intensity during three days. Each inflamed prick of the lancet re-
sembled, on the fourth day, a commencing vaccine pustule. On the fifth day
after the inoculation the inflammation had disappeared. There was no general
fever, and the health of the little patient was not disturbed in the slightest
degree.
Experiment 2. — Fifteen days after the date last mentioned in the foregoing
case, the other children of Dennis Carron were affected with scarlatina. M. Mi-
guel now received the matter on twenty-four lancets, as in the preceding case,
and within an hour again inoculated the little child which was the subject of
the former observation, in six different places. The incisions now made did not
become red, or exhibit any sign of a morbid action taking place in the part. M.
480 QUARTERLY PERISCOPE.
Miguel after this proceeded to the house of another nurse, and inoculated three
young children, by making six incisions of the charge lancets on the arm of
each. These experiments gave rise to inflammation in the case of one child
only, aged four years; three of the lancet pricks inflamed, and produced as
many points, which followed the same march as in the case of Carron's child,
already described. This new inoculation is regarded by the author as nearly
decisive of the question, for if the inflammation which took place in the arm of
the first infant was merely traumatic, why was it not renewed on the second
application of the virus, and why in the latter experiment did eighteen inci-
sions give rise only to the formation of three pustules, which, as in the case of
the child twenty-eight months old, followed the march of a scarlatinous inflam-
mation?
Experiment Z.—lt now remained to determine whether this local affection was
a preservative against the scarlatina. On the 18th of January, 1834, the author
was called upon to see the child of a mason, named Boce, affected with scar-
latina anginosa of the most severe form. The disease had existed twenty-four
hours. The man, his wife, and three children, inhabited one low, damp, ill-
aired apartment, and it was impossible to separate the sick child from the others.
M. Miguel had frequently observed, that when scarlatina breaks out in a family,
the first case usually precedes the others by twelve or fifteen days; he, therefore,
proposed on the third day to charge a lancet by making an incision on the fore-
arm of the sick child, where the eruption was most abundant, and to inoculate
the virus into the other children. The mother consented to this proposal, and,
accordingly, ten incisions were made in the thighs of a little sister, nine years
of age, with a charged lancet. The boy, aged about twenty months, was in-
oculated in six different points; the epidermis alone was raised up on the point
of the lancet, as in vaccination. On the following morning the incisions made
in the thigh of the little girl were transformed into as many black points, from
dried blood, each surrounded with a small red areola. On the second day this
areola was larger, and of a deeper red. On the third day, the inflammatory
circle remained stationary, but the skin of this part seemed to have become a
little thicker than natural. The inflammation resembled exactly, in form, colour,
and tumour, a papula of scarlatina. On the fourth day there was no change,
and on the fifth all trace of inflammation had nearly disappeared, the skin re-
maining only a little brown. There was no fever, nor enlargement of the
axillary ganglia. As to the boy, five of the incisions only became swollen and
red like those of his sister: they were somewhat more developed and of a
deeper colour than her's, a circumstance that might be attributed to the greater
tenderness and vascularity of the skin in this young subject. Since the 19th of
January up to the 1st of April these children have inhabited the same chamber,
and slept on the same bed with their sister. No precaution of any kind was
taken to preserve them from contracting the infection, yet both have remained
perfectly healthy, and free from any eruptive attack.
These facts, though not sufficiently numerous to decide a question of this
kind, are not without considerable interest, and should engage physicians to
report, on as extensive a scale as possible, the experiments detailed.
MATERIA MEDICA.
22. Some Remarks on the Plant which yields the Cascarilla Bark. By David
Doi!f, Esq. — There is reason to believe that many species of Croton afford a
bark partaking more or less of the properties of cascarilla, and indeed this
opinion is borne out by analogy with other genera among whose members si-
milar qualities are generally found to prevail. It is a curious fact, however,
that the Crotun. cascarilla of Linnseus possesses none of the sensible properties
of cascarilla bark. The late Dr. Wright, whose knowledge of the medicinal
Materia Medica. 481
plants of Jamaica was unrivalled, appears to have been the first to determine
this fact, and that the bark in qviestion was derived from the Cruton eluteria^
of which a faithful representation will be found in Sloane's Jamaica, (vol. ii. t.
174. f. 2,) referred incorrectly by Linnaeus to his Croton glabellum. The same
opinion seems also to have been entertained by Linnaeus himself, for in the first
edition of his 3Iateria Medica, the Cascarillse cortex is mentioned as one of the
products ofClutia eluteria, but he afterwards, as now appears on very insufficient
grounds, altered his opinion in favour of a plant with which he was entirely un-
acquainted, except from the figure in Catesby's Carohna, (vol. ii. t. 46.) Of
this plant, which he named Clutia cascarilla, he had then seen no specimen, and
in the Species Plantaruni, where it occurs for the first time, he has stamped it
with the usual mark of an obscure species. Of Clutia eluteria he had a sample,
from which he evidently drew up his description, in the Anioenitaies JlcademicsR,
although he confounded with it a Ceylonese plant, which he had taken up in
the Flora Zeylanica from Hermann, and likewise two other totally different
species, the first figured by Plukenet, which is Croton micans of Swartz, and
the second by Seba, f Thesaurus, vol. i. t. 35. f. 3.) In the Lambertian Her-
barium, there is a specimen from Curacao exactly resembhng the last-mention-
ed figure, which I should be inclined to refer to Croton niiens of Sv/artz. The
specific character, which occurs throughout all Linnsus* works, of Clutia, or
rather Croton eluteria, appears to refer entirely to the Ceylon plant, whose his-
tory is still involved in great obscurity.
Dr. Wright considered the Elutheria and Cascarilla barks as the produce of
Croton eluteria, and this opinion is now pretty generally adopted by pharma-
ceutical writers; but I am disposed to regard them as derived from two distinct
species, and I rather incline to the opinion of Boulduc, Spielman, and others,
that the cascarilla bark is a production of the Spanish Main, for it does not ap-
pear that it ever was obtained from Jamaica, or even from the Bahama Islands,
(from one of which the appellation Eluteria or Eleutheria is derived,) and it is
now ascertained, from the recent observations of Messieurs Schiede and Deppe,
that a bark, agreeing in every particular with the cascarilla bark of the shops,
is collected extensively in the vicinity of Jalapa, at Actopan, and in the dis-
trict of Plandel Rio, in the province of Vera Cruz, Mexico, where it is known
by the names of Copalche or Quina Blanca. These gentlemen considered the
plant at the time to be identical v/ith the Croton eluteria, but although closely
related, it is nevertheless essentially distinct from that species, differing in its
broadly cordate, 5-nerved leaves, which are slightly peltate at their insertion,
and of a more coriaceous texture. In Croton eluteria the leaves are ovate-
oblong or elliptical, furnished with a solitary midi'ib, having obliquely trans-
verse ramifications, and the base either obtuse or somewhat attenuated, but
neither cordate nor peltate. The inflorescence is racemose, and in other
respects nearly similar in both species. Tlie tree grows to the height of
twenty-five or thirty feet, is much branched, and clothed with a profusion of
broadly cordate leaves, silvery underneath, and numerous clusters of white
flowers. The bark is exteriorly of a gray colour, pale brown within, of an even
fracture, possessing a strong aromatic flavour, and an agreeable bitter taste,
and in other respects accords with the Cascarilla bark of the shops, for I have
carefully compared samples of the bark sent by Messieurs Schiede and Deppe
with others from the Apothecaries' Hall, and I think there cannot be a question
as to their identity. To the Mexican species I would recomiuend the applica-
tion of the name of Croton cascarilla, that of Pseudo-China given to it by Pro-
fessor Schlechtendal, in his recent treatise on the subject, being in many
respects objectionable, and leaving to the Croton cascarilla of Linnaeus the
more recent epithet of linearis, applied to it by Jacquin, being perfectly con-
vinced of the identity of the latter with the Linnean Cascarilla, and that the
distinctions hitherto relied on to keep them apart are of too trivial and variable
a nature to be entitled to the importance which has been assigned them. The
No. XXVIIL— August, 1834. 41
482 QUARTERLY PERISCOPE.
specimen in the Linnean Herbarium appears to have been communicated by
FhiUp Miller, and belongs to the West India variety, with narrower leaves, and
consequently is what Jacquin meant by his Croton linearis. The glands at the
insertion of the leaf, I observe, vary from two to four, although, in the specific
character of linearis, they are stated to be uniformly two, and three in Croton
cascarilla. — The Edinburgh New PhilosophicalJournal, Aprils 1834.
23. Febrifuge Properties of Salicine. By M. Richelot. — The bark of the
white, crack, and Huntingdon willow, was long ago employed in the treatment
of ague with various success; but its power over the disease appeared to be
very questionable. The first chemists who analyzed it discovered in it no al-
kaline principle similar to quinine or cinchonine, and it gradually fell into disre-
pute. Fontana, however, maintained the existence of a certain febrifuge prin-
ciple, to which he gave the name of Salicine. His opinion has since been cor-
roborated by Buchner, Rigatelli, and Leroux, the last of whom was the first to
employ it in France. Numerous trials were made of it in various quarters, and,
of course, from possessing the charm of novelty, its praises were sounded in no
ordinary tone. Doubts, however, continued to be entertained, which were con-
firmed by the result of some trials made at La Charite by M. Pelletier, by which
it appeared, that in his hands, salicine, though very bitter, seemed to be far
less active than the principle of the cinchonas.
Dr. Richelot mentions the trials made by various of its supporters, the results
of which appear to be altogether negative, while other experiments tended
to show that it is possessed of no obvious febrifuge power. The doses given
in these experiments, varied from six to twenty-four grains. With the view of
settling the question, M. Andral instituted several experiments, the particulars
of which are recorded by M. Richelot. Ten patients of different sexes, whose
ages varied from seventeen to thirty-eight, were selected for the purpose, and,
after considering the results of these, as well as all that has been mentioned by
others, M. Richelot comes to these conclusions: — 1st, Salicine appears really to
possess febrifuge qualities, but in so small a degree that we ought not to hesi-
tate a moment in preferring the sulphate of quinine. 2d, Salicine may be em-
ployed in any case where irritation or inflammation exists, contraindicating the
employment of the sulphate of quinine, in hectic fevers with periodical pa-
roxysms and abundant diarrhoea, or where sulphate of quinine cannot be had.
3d, It is not only unnecessary but injudicious to employ it at the beginning in
high doses. Six or eight grains administered between the paroxysms, on the
same principles as sulphate of quinine, produce as good or even better effects
than higher doses, though, if necessary, the doses may be increased. — Edin-
burgh Med. and Surg. Journ. from Archives Generales, September^ 1833.
24. Neiv Anthelmintic. Spigele anthelmintique, or Arapabaca. — In a short
memoir on the virtues of the above-named plant, M. Noverue, physician at Mar-
tinique, has drawn the attention of practitioners to the arapabaca, as an anthel-
mintic which is infallible in its action, enjoys a sedative power, and is also pos-
sessed of a peculiar property, which admits of its being administered in all pos-
sible cases, without aggravating inflammatory symptoms, should they happen
to complicate the presence of worms in the intestinal canal. This latter quality
gives it an immense advantage over turpentine and other stimulant purgatives,
which are at present so universally employed in worm cases; and has been re-
cognised in the plant by all physicians who practise in Gaudaloupe, Cayenne,
Mai'tinique, and South America.
The *' Spigele anthelmintique," arapabaca, is an herbaceous annual plant, of
the pentandria monogynia, growing in South America. The stem of the plant
is round, and the leaf verticillated round the summit. It is commonly adminis-
tered in the form of syrup, of which three spoonfuls are given to an adult, or to
a child of three years old a tea-spoonful. At the moment of administration it
is customary to add a spoonful of cold water and a few drops of lemon-juice.
Materia Medica. 4S3
The same dose is repeated for three days, and then a mild purgative is given.
A singular effect of the medicine is sometimes the production of a shght amau-
rosis, when it is administered under the influence of solar or artificial light.
Amongst the most remarkable properties of this remedy the author enumerates
the following: — Its action is always efficacious: it is agreeable to the taste, and
children always take it without evincing any repugnance. Enjoying a sedative
property, it calms the nervous symptoms which so frequently complicate the
verminous disorders of childhood. It is not calculated to produce or aggravate
inflammation of the intestinal canal, and may therefore be administered in cases
where most other anthelmintics are inadmissible. However, it is prudent not
to administer it whenever there are any symptoms of cerebral congestion; for
it is a narcotic acrid poison, and if given in too strong a dose, may occasion se-
vere accidents. The action of the plant generally takes place on the second,
or even the first day after its administration. The author supports this asser-
tion by an enumeration of cases in which the efficacy of the remedy as an an-
thelmintic is fully established; and says, it is administered with confidence by
all the inhabitants and practitioners of the Antilles and Martinique. — Lancet,
from Gaz. Med.
25. Active Principle of Sarsaparilla. — M. Batka attributes the properties of
sarsaparilla to a peculiar acid, to which he has given the name of parillinic. In
the state of hydrate, this acid resembles fish scales; melted it might be taken
for a resin. It reddens litmus paper, and dissolves in alcohol, from which it
separates in a crystallized state by evaporation; it is very little soluble in cold
water, but dissolves very readily in boiling water, to which it communi-
cates the property of foaming. The chlorate of calcium and of mineral acids,
such as hydrochloric acid, precipitate it in gelatinous flocculi. Nitric acid dis-
solves it without changing its nature. It forms with the alkalies soluble combina-
tions, uncrystallizable, and v/hich communicate to water the property of froth-
ing, like the infusions of sarsaparilla. In order to obtain parillinic acid, M.
Batka prepared an extract of sarsaparilla with pure alcohol, treated this extract
with boiling water, which dissolves the parillinic acid, evaporated to dryness,
and redissolved the residue by hydrochloric acid; the parillinic acid separates
in flocculi, which he washes, and afterv/ards dries. — Journal de Pharmacie,
Dec. 1833. •
26. Extract of Guaiacum. — M. Soubeiiian has published in the January
No. (1834,) of the Journal de Pharmacie, some observations on the extracts of
guaiacum, which merit the attention of practitioners. The wood of the guaia-
cum is very resinous, and on the contrary contains but a very small portion of
extractive matter and gum, which therapeutic experiments have not shown to
possess very marked properties. It results that cold water dissolves but little
of the guaiacum, and that it cannot be dissolved in any great quantity except
by long boiling, during which the extractive matters dissolve in some degree
the masses of resin which have been softened and detached by boiling. Hence
we must conclude, that to derive any effects from watery drinks prepared with
the guaiacum, this substance must be employed in large quantities, divided in
very small pieces, and long boiled. The different formulae recommend the
extract of guaiacum to be prepared by decoction, and the resinous deposit
which form.s as the evaporation proceeds, to be carefully separated. It is evi-
dent from the above, that the extract thus obtained is entirely destitute of re-
sin, that is, of the most active principle of guaiacum. It is better as recom-
mended by the Geneva pharmacopoeia not to separate the deposit which forms
during the evaporation, but to divide it, on the contrary, in the extract by
means of a small quantity of alcohol, or to use only the resin of guaiacum, or the
decoction itself, vi^hich in fact is but a particular mode of obtaining the resin
of the guaiacum diffused in an aqueous vehicle.
484 QUARTERLY PERISCOPE.
17. Experiments on the Therapeutic Properties of Codeine. — This new alkaline
substance has been recently obtained from opium by M. Robiquet, and its the-
rapeutic effects have been studied at Amiens by M. Barbiek, surgeon to the
Hutel-Dieu of Amiens, who communicated some observations on them to a late
sitting- of the Royal Academy of Medicine. These efforts seem to establish the
chemical specialty of codeine, differing- as they evidently do from either opium
oi' morphine. The codeine was administered in the dose of one or two grains.
Like opium and all medicinal substances derived from that drug, codeine ope-
rates on the nervous system, but its medical influence seems very small on the
brain; it makes no impression whatever on the spinal marrow or nerves derived
from it, and its whole activity seems to be exhausted on the nervous plexus of
the g-reat sympathetic. Thus, in cases of gastralgia, characterized by pain in
the epigastric region, and a sensation of burning- about that part, with paleness
of tlie countenance, anxiety, &c., condeine has quickly dissipated all the acci-
dents which it is impossible not to refer to the nervous plexus of the great sym-
pathetic. M. Barbier has also seen codeine produce considerable alleviation in
cases were the tunics of the stomach were beyond all doubt degenerated. Co-
deine also produces sleep when given in sufficient quantity, but this sleep differs
from that occasioned by opium; it is never accompanied by a sensation of weight in
the head, dizziness, &,c., nor does its administration ever g-ive rise to cerebral
congestion. M. Barbier has been convinced by the observation of several facts
that codeine has no influence over the spinal marrow or its nerves. Many pa-
tients affected with the g-astralg-ic pains already alluded to, had also neuralgic
pains in the head, loins, thighs, &c.; the uneasiness about the abdomen was
quickly relieved by the remedy, but the pains in the limbs, back, &c., remained
unchanged. This occurred upon so many occasions as to leave no doubt on the
subject. It is necessary to remark, that all the patients on whom the codeine
was tried, had previously employed, without any benefit, the liquid laudanum
of Sydenham. Codeine does not produce any apparent change in the exer-
dse of the circulation or respiration, nor does it disturb the digestive organs
OT produce constipation. When applied to the skin, it has not given rise to any
remarkable phenomena. In one case, two grains were applied to the surface
of a recent blister, but the neuralgic pains for which the blister had been em-
ployed were not in the least alleviated. — Lancet and Gaz. Med. 8th March, 1834,
28. First Effect of Cataplasms on the Skin produced forty-eight Hours after
their Removal. — A very interesting example of this is related by T. W, Cheva-
UEE, Esq. in the London Medical Gazette, of 5th of April last. The patient, when
in a state of apoplectic insensibility, had mustard plasters applied to his feet,
and their application continued forty-eight hours, because they produced during
that period no sensible effect. They were then removed, and after a second in^
terval of forty-eight hours, and after sensibility was restored, it was observed
that tile feet first became flushed and inflamed, and presently began to blistei?
upon the soles, tlie heel, and the instep, to an extent which it was painful to
witness.
There are probably few practitioners of any experience who have not wit-
nessed ill effects resulting from the too long application of cataplasms and blis-
ters, especially to patients whose consciousness is dull. The rule usually fol-
lowed, not to remove sinapisms until they become extremely painful, or until
the patients exhibit evidence of feeling them, and of keeping on blisters until
they draw, cannot, in many cases, be too strongly reprobated. The worst
ulcers, and the most difficult to heal, that we have ever met with, were pro-
duced by the patient following the instructions of their physician, to keep on
the cataplasm as long as they could bear it.
*' I have always observed," says Mr. Chevalier, " in the use of the mustard
cataplasms, that its sensible operation on the skin, in unconscious patients, and
in such as are suffering, at the time of its application, from collapse, is not by
any means in direct proportion to the effects which it produces some days after
Practice of Medicine. 485
its removal; while, even in patients who can make known their complaints, the
impression that will be made by such applications is not to be calculated from
the visible and palpable irritation produced by them while applied.
"Besides extensive experience, much science is required to estimate, to any
certainty, the consequences of an excoriating- application, especially to the skin
of young persons. The severest is the safest, as most likely to warn the igno-
rant practitioner of its imminent effects; but I have seen three children lying
dead at once, from blisters kept on for twenty-four hours, because, in that
time, they had not raised the cuticle; for when they raised it, which was as
long afterwards, the integuments sloughed, and they all three died of the
sloughing-. *
**A common blister, applied to most persons for six hours only, will rise
about the twelfth or eighteenth, although it has been removed at the end of
the six; for the irritation, although not sensibly affected at that time, is really
and effectually accomplished; and we may safely adopt it as a rule, that sina-
pisms, or any other excoriants, are not to be continued on the body according
to their effect while thereon, but according to the general experience of our
profession with respect to the irritation they afterwards produce, and that it is
an error to continue their application after the period in which they may be
reasonably expected to have insured the future blush, vesicle, or superficial
mortification, expected from them; since, in awaiting their first notable opera-
tion on the skin, we may perhaps insure a greater degree of mischief than it is
in the power of the ablest practitioner to allay or controul.
**It appears to me, that ignorance of this aphorism, (if I may so call the doc-
trine I have ventured to promulgate,) and ignorance of the facts on which it
rests, have led to the many cruel deaths, inflicted even in this metropolis, not
long" ago, on patients who were merely suspected, or pretended, to be liable to
internal diseases, removeable by external irritation. In the legitimate use of
unguentum antimonii tartarizati, for example, we do not rub it in till the pus-
tules appear, but for so many minutes, in expectation of their future develop-
ment, and in due time they rise; but if we persevere too long in the infriction
of that ointment, of St. John Long's nostra, sinapisms, or any similar remedy;,
the consequence may be fatal, as has been proved by facts equally notorious
and deplorable."
PRACTICE OF MEDICINE.
29. Treatment of Acute Gastritis. By William Stokes, M. D. — We now
come to treat of simple acute gastritis. Here there are three principal indica-
tions. One of these is to remove inflammation as speedily as possible. You.
cannot, as under other circumstances, leave this disease to nature; the organ
affected is one of the utmost importance to life; and if you do not cut it short
at once, a typhoid state comes on, to which the ordinary and efficient means of
antiphlogistic treatment are inapplicable. The first indication then is to cut
short the inflammation as speedily as possible. The next thing is to prevent
the introduction of any thing into the stomach which will excite the physiolo-
gical action of that viscus. You are aware that while the stomach is engaged
in the process of digestion, its vascularity is very much increased, and that this,
which in health is merely a physiological condition, is unaccompanied by any
kind of danger. But in a state of disease it proves a source of violent excite-
ment, and superadds very much to the existing inflammation. You must, there-
fore, be extremely cautious with respect to what enters your patient's stomach,
and carefully remove every thing capable of adding to the excitement which
* " After the sloughing took place, those children were under the best possible care."
41*
486 QUARTEftL'K' PERISCOPE*
always attends gastritis. The third indication in the treatment is to modify and
remove the sympathetic or secondary irritations.
Now I shall suppose that M'e have to treat a case of simple acute gastritis not
produced by the swallowing of corrosive poison or indigestible food. Here we
have a patient labouring under violent inflammation of one of the most import-
ant organs in the body; and the question is, are you to adopt the ordinary and
usual mode of stopping inflammation by opening a vein in the arm? I must
here state, that we are very much in want of a series of well-established facts
to guide our practice on this point, and to inform us how far general bleeding
is useful in acute inflammation of the stomach. At the present period, the
question is by no means settled, and the practice is uncertain. I believe, how-
ever, that when we are called in at an early period of the disease, wliere the
patient is young and robust, the stomach previously healthy, the fever high,
and the pain great, we may have recourse to general bleeding with advantage;
bearing this in mind, however, that you are not to expect to cut short the in-
flammation by the use of the lancet. Inflammations of the raucous membrane
of the stomach and bowels, and perhaps of the lungs, are not to be overcome
at once by the lancet; the only cases in which you can expect to cut short an
inflammatory attack are those in which the parenchymatous tissue of an organ,
or its serous membrane, is aflTected. This is a general and important law. You
will often be able to cut short a hepatitis or a pneumonia by a single bleeding,
but you will not by the same means be able to repress a bronchitis or an in-
flammation of the mucous membrane of the intestines. If you bleed in gastritis,
bleed at an early period; not too largely, or with the expectation of cutting
short the inflammation, but in order to prepare your patient for the grand,
agent in efi^ecting a cure — local bleeding. This is the principle on which you
are to employ the lancet.
In the treatment of gastritis there is nothing more useful, nothing more de-
cidedly efiicacious, than the free and repeated application of leeches, whether
the case be idiopathic, or produced by the swallowing of a corrosive poison.
In this treatment of acute gastritis, you will frequently see, perhaps, the most
striking instances of the rapid and decided utility of medical treatment; you
will see the vomiting subside almost immediately, the epigastric pain and ten-
derness disappear, the cough and head-ache relieved, the fever subside, and
the tongue change after the application of leeches. To remove the symptoms,
the best and most effectual means are leeches; and these must be applied again
and again, according to the duration and obstinancy of the symptoms. Here I
Vv'ish to make one remark of importance. From an opinion very prevalent in
former times, that pain and inflammation were inseparable, the older practi-
tioners thought that when the pain ceased the inflammation also ceased; and
hence many of our predecessors, and I fear some of our contemporaries, never
think of reapplying leeches, no matter what the existing symptoms may be, if
pain has been relieved by the first application. Nothing is more erroneous
than this practice. It frequently happens that the pain and epigastric tender-
ness are removed by the first application of leeches, but the breathing is still
quick, the fever high, and the thirst ardent. So long as these symptoms re-
main, the inflammation of the stomach is still going on. The mere subsidence
of pain or tenderness of the epigastrium should never prevent us from resort-
ing to the application of leeches. In leeching the belly for inflammation of the
stomach or bowels, it is a common practice to apply a poultice over the leech
bites, with the view of getting away as much blood as possible. I am not in-
clined to approve of this practice. The weight of a poultice is frequently
troublesome, and the heat produced by it disagreeable; the patients desire cold,
and for this purpose they will often throw off their bed-clothes, feeling a de-
gree of relief from exposing the epigastrium to a stream of cool air. Some
practitioners have applied pounded ice over the stomach with good effects, as
we see it frequently applied to the head with the same results in cases of ence-
Practice of Medicine. 487
phalltis. Again, the application of poultices causes an oozing* haemorrhage, the
amount of which it is impossible to calculate, which is often hard to be arrested,
and which, in debilitated persons and children, has the effect of lessening the
powers of life without removing the original disease. It is much better to
leech again and again than to do this. AVhere there is not much epigastric
tenderness you may apply a cupping-glass over the leech bites with advantage,
as you can get away as much blood as you choose, and the tendency to after-
hsemorrhage from the leech bites is diminished by the application of the cup-
ping-glass. In very young subjects the tendency to obstinate haemorrhage
from leech bites is so great, that many practitioners are afraid to use leeches,
and I believe some children have been sacrificed to this fear. The best mode
of managing this is, if the leech bites cannot be stopped by the ordinary means,
(and in very young children they seldom can,) to stop them at once by the ap-
phcation of caustic. Do not lose time in trying to arrest the flow of blood with
flour, or lint, or sticking plaster; wipe the blood off the bite with a piece of
soft dry lint, plunge into it a piece of lunar caustic scraped to a point, give it a
turn or two, and the v/hole thing is settled; and you can generally go away
with the agreeable consciousness of having prevented all further danger, and
without being uneasy lest your patient should bleed to death in your absence.
With respect to the management of the bowels in acute gastritis, a few ob-
servations will suffice. You will always have to obviate the effects of constipa-
tion; both in the acute and chronic form of the disease there is always more or
less constipation; in fact, the same condition of the bowels is generally observed
in both. Now, if you attempt to relieve this constipation in acute gastritis, by
administering purgatives, you will most certaiwly do a vast deal of mischief.
Nothing can exceed the irritability of the stomach in such cases; the mildest
purgatives are instantly rejected, even cold water, or effervescing draughts are
often not retained, and a single pill or powder is frequently thrown up the mo-
ment it is swallowed. Under such circumstances, it is plain that the adminis-
tration of purgative medicine is totally out of the question. Even though the
stomach should retain the purgative, you purchase its operation at too dear a
price; for it invariably proves a source of violent exacerbation, kindling fresh
inflammation in an organ already too much excited. In this state of things the
best thing you can employ to remove constipation is a purgative enema, re-
peating it according to the urgency or necessity of the case. Where there is
no inflammation in the lower part of the intestinal canal, you may employ in-
jections of a strong and stimulating nature, with the view not merely of open-
ing the bowels, but also of exercising a powerful revulsive action. I shall men-
tion here an interesting fact, proving that stimulant injections have a decided
revulsive effect; and that their influence extends not only to other portions of
the intestinal tube, but also to distant parts of the system. In South Americaj
where, from the heat of the climate, and the prevalence of bilious affections,
sick head-ache is a very common and distressing symptom, a common mode of
cure is to throw up the rectum an extraordinary enema, composed of fresh cap-
sicum, and other aromatic stimulants. The irritation which this produces acts
as a very efficacious and speedy revulsive, causing the almost immediate re-
moval of the cerebral symptoms.
In those cases of gastritis, where not only purgatives, but even the mildest
substances are rejected, the plain common sense rule is to give nothing. Where
cold water is borne by the stomach, it may be taken in small quantities, as of-
ten as the patient requires it. Solid ice, too, may be given with decided bene-
fit. There is a mistake which prevails with respect to the employment of ice
in gastritis, which I wish to correct. Some persons object to its use, and rea-
son in this way: — persons who have taken a quantity of cold water, or ice,
when heated by exercise, have been frequently attacked with gastritis and
fever, and consequently the use of these substances must be attended with dan-
ger in case of gastric inflammation. This, however, is false reasoning; you
need not be afraid to order your patient ice ad libitum; depend upon it, there
48S QUARTERLY PERISCOPE.
is no danger in employing' either ice or cold water in gastritis. There is nothing"
so grateful to the patient as ice. Let a quantity of it be broken up into small
pieces about the size of a walnut; let your patient take one of these pieces,
and having held it in his mouth for a few moments to soften down its angles,
let him swallow it whole. The effect produced by this on the inflamed sur-
face of the stomach is exceedingly grateful, and the patient has scarcely swal-
lowed one portion when he calls for another with avidity. It will be no harm,
gentlemen, if I should here mention to you a secret worth knowing. There
are few things so good for that miserable sickness of the stomach, which some
of you may have felt after a night's jollification with a set of pleasant fellows,
as a glass of ice; Byron's hock and soda-water are nothing to it.
After the first violent symptoms of the disease have been subdued, I believe
the very best thing which can be given is cold chicken broth. The point
which we are always to keep in view is to remove inflammation from the sto-
mach, and this should regulate the use of every thing taken into the stomach.
I believe v/e might derive much advantage from anodyne injections in gastritis.
I cannot say that I have ever employed them in such cases; but if I were to
reason from their utility in other forms of abdominal inflammation, I should be
induced to look upon them as entitled to some consideration. There is another
point to which I will briefly advert. In the treatment of acute gastritis, there
is nothing more commonly used than effervescing draughts; yet I have fre-
quently seen them produce distinct irritation of the stomach. In cases where
gastric irritability is excessive, I would not advise you to give effervescing
draughts, or if you do, watch their immediate effect; see how the first one has
agreed with the stomach before you venture to give any more. Patients la-
bouring under this disease should be kept extremely quiet, as frequently a
slight motion brings back the vomiting. Everything which is swallowed should
be in small quantity; a large quantity of any substance frequently causes a re-
turn of the vomiting, by distending and irritating the stomach. One of the
best things you can give, and the best way of giving it, is iced lemonade, giving
a table-spoonful from time to time. The extremities, which are generally cold
in cases of intestinal disease, should be swathed in warm flannel.
I shall mention here a rule which should be carefully observed in the after-
treatment. A patient has recovered from the violent symptoms of the disease;
the fever, tliirst, pain, epigastric tenderness, and sympathetic affections have
subsided; but he still is confined to bed, and in a state of great debihty. Some
patients under these circumstances have been unfortunately lost by allowing
them to sit up in bed, or on the night chair. The nurse will sometimes,
through ignorance, suffer a patient, thus enfeebled, to risk his life by sitting
up in bed; sometimes during the course of the night she is overcome by sleep;
the patient has a call to empty his bowels; and not wishing to disturb her, at-
tempts to get up, and is found in some time afterwards sitting on the night
chair quite dead. This is an unfortunate termination for the physician, as well as
the patient. A German author, Hoffmann, has written a treatise on the danger
of the erect position after acute diseases; and in the course of the work, which
is a very interesting one, he cites numerous instances of its bad effects. Not
very long since, a patient was lost in the Meath Hospital by the nurse allowing
him to sit up after a severe attack of enteritis. Such also was the melancholy
cause of death in the case of the late Mr. Hewson, one of my best and earliest
friends. He got a severe attack, which was subdued with difficulty, and his
convalescence was doubtful and protracted. One night, in the absence of his
attendant, he got up for the purpose of emptying his bowels, and was found
some time afterwards on the night chair nearly dead. He was immediately
brought back to bed, and the necessary means employed to relieve him, but
without much benefit, for he never recovered the effect produced on his debi-
litated frame. — Lond. Med. and Surg. Journ. January 18^A, 1834.
30. Treatment of Chronic Gastritis. By William Stokes, M. D.— [Extracted
Fractice of Medicine, 489
from Lectures on Practice of Medicine.] — The first thing* you should do, when
called to treat a case of d^^spepsia, is to ascertain whether it be a purely ner-
^^ous disease, or a chronic gastritis. The majority of practitioners give them-
ftelves no trouble about this matter, not recognising the fact, that, of the num-
ber of dyspeptic persons who seek for medical advice, a considerable propor-
tion are really labouring under a chronic gastritis, and forgetting that in con-
sequence of long-continued functional injury, what was at first but a mere ner-
vous derangement may afterwards become complicated with organic disease.
You must also bear in mind, that the stomach is perhaps placed under more
unfavourable circumstances for bringing about a cure than any other organ,
because the life of the individuals demands that the stomach, though in a state
of inflammation, should still continue to perform its functions. In treating dis-
eases of other organs, you will have the advantage of a comparative state of
rest, but in a case of the stomach, if you wish to preserve life, you cannot pro-
hibit nutriment, and consequently you must run the risk of keeping up these
periodic vascularities which its condition requires, which, though harmless in
health, become a source of evil when the stomach is diseased. The obvious
deduction from this is, that the cure of a chronic gastritis depends as much
upon regimen as upon medical treatment, and particularly where the symptoms
have arisen from long-continued excitement, as in the case of persons who live
highly. Here the treatment chiefly depends on regulating the diet, and if your
patient has sense enough to live sparingly for a few weeks or months, you may
be able to effect a cure without other treatment. The great error is, that most
practitioners attempt to cure the disease by specifics, and when these fail, they
then go to the symptomatic treatment, prescribing sometimes for acidity, some-
times for nausea, sometimes for flatulence, sometimes for constipation, or "the
iiver," or debility.
You should be careful in the examination of such cases, and should try to
ascertain, whether these symptoms may not depend upon inflammation of the
stomach; for as long as the patient is in this state, the less you have recourse
to symptomatic or specific treatment the better. It is hard to mention one sin-
gle medicine which in this state will not prove stimulant, and if the stomach be
unfit for stimulants, it must be unfit for the generality of medicines. There
are numbers of cases of persons labouring under chronic gastritis, which have
been cured by strict regulation of diet, and by avoiding every article of food
requiring strong digestive powers. We find that articles of diet vary very
much in this respect; some are digested v/ith ease, some vv^ith pain. We might
express this otherwise, by saying, that some require very little excitement of
the stomach, and others very great vascular excitement. Patients in this irri-
table state of stomach, can scarcely bear any kind of ingesta; and when you
consider the great vascularity, thickening of the mucous membrane, and ten-
dency to organic disease, you will be induced to think that every thing enter-
ing the stomach should be of the mildest kind, and not requiring any powerful
determination of blood to that organ.
If you continually prescribe for symptoms, neglecting or overlooking the
real nature of the disease, giving arsenic to excite the system, and iron to re-
move ansemia, and bitter tonics to improve the appetite, and alkaline remedies
for acidity, and carminatives to expel flatus, you will do no good; you may
chance to give relief to-day, and find your patient worse to-morrow; and at last
he will die, and you may be disgraced. On opening the stomach after death,
you are astonished to find extensive ulceration, or perhaps cancerous disease.
Very often, in such cases, practitioners say that it is cancerous disease, and that
no good can be done. But the thing is to be able to know, when you are
called to a case, whether it is a case of mere nervous dyspepsia, or chronic in-
flammation of the stomach. Some of the best pathologists think that most of
the cancerous affections of the stomach are in the beginning only chronic in-
flammations of that organ.
I believe we have not yet in this country adopted the plan of moderate ap-
490 QUARTERLY PERISCOPE.
plication of leeches to the epigastrium in cases of chronic gastritis. I have
seen in many cases great benefit result from the repeated application of a small
number of leeches to the epigastrium, at intervals of two or three days. Here
is a point which you will find very useful in practice. You will meet with cases
which have lasted for a long time; cases where there is strong evidence of or-
ganic disease, and which have resisted the ordinary dyspeptic treatment. You
will be called frequently to treat these three different cases, where the disease
has been of long duration, where there is distinct evidence of organic disease,
and where the disease has resisted the ordinary dyspeptic treatment. Here is
a case of a patient labouring under what is called indigestion, and which has
resisted the stimulant, and tonic, and purgative treatment. — Here is one fact.
In the next place, the disease is chronic, and the probability is, that there is
inflammation, and consequently that there is chronic gastritis. Now if, in such
a case, you omit all medicine by the mouth, apply leeches to the epigastrium,
keep the bowels open by injections, and regulate the diet, you will often do a
vast deal of good. I have seen, under this treatment, the tongue clean, the
pain and tenderness of the epigastrium subside, the acidity, thirst, nausea, and
flatulence removed, the power of digestion restored, and all the symptoms for
which alkalies, and acids, and tonics, and purgatives were prescribed, vanish
under treatment calculated to remove chronic inflammation of the stomach.
What is next in importance to regulated regimen and local bleeding? — A
careful attention to the bowels, which in chronic gastritis are generally consti-
pated, and this has a tendency to keep up disease in the upper part of the di-
gestive tube. Is this to be obviated by introducing purgative medicine into
the stomachi' — No. If you introduce strong purgative medicine by the mouth,
you will do a great deal of mischief. You must open the bowels by enemata,
or if you give medicine by the mouth, by the mildest laxatives in a state of
g-reat dilution. A little castor oil, given every third or fourth day, or a little
rhubarb with some of the neutral salts, will answer in most cases. The diet,
too, can be managed, so as to have a gently laxative effect. The use of injec-
tions is, however, what I principally rely on. I have seen many cases of gas-
tritis cured by the total omission of all medicine by the mouth, by giving up
every article of food which disagreed with the stomach, and by the use of
warm water enemata. I have seen this treatment relieve and cure persons
whose suflTerings had lasted for years previous to its employment, and who had
been considered by eminent practitioners to labour under organic disease of an
incurable nature. It is important that you should bear this in mind. The old
purgative and mercurial treatment of gastritis, I am happy to say, is rapidly de-
clining; and British practitioners are now convinced, that they cannot cure
every form of dyspepsia by the old mode of treatment. I do not deny that
many diseases of the digestive tube may be benefited by the mild use of mer-
cury and laxatives, but I think I have every reasonable and scientific practi-
tioner with me in condemning the unscientific routine practice, which was fol-
lowed by those who took the writings of Abernethy and Hamilton for their
guide. I do not say that, where cases of gastric inflammation, treated after the
plan of Mr. Abernethy, have proved fatal, the medicines have destroyed life; I
merely assert that the patients died of inflammation, over which these medi-
cines had no controul; and the error lay in mistaking and overlooking the ac-
tual disease, as much as in its maltreatment. You will find some practitioners,
(they are becoming fewer in number every day,) who seem to have but two
ideas, the one a purgative, the other a pot full of faeces; but the connecting
link, — the gastro-enteric mucous membrane, — that vast expansion, so compli-
cated, so delicate, so important, seems to be totally forgotten. But practi-
tioners are now beginning to see that purgatives are not to be employed empi-
rically; that they should be administered in many cases with great caution, and
with a due attention to the actual condition of the alimentary canal, and that
they have been a source of great abuse in the medical practice of these
countries.
Practice of Medicine, 491
Next to leeching and a proper regulation of the bowels is the employment of
gentle and long-continued counter-irritation over the stomach. This may bo
effected by the repeated application of small blisters, or by the use of tartar
emetic ointment. 1 have been in the habit of impressing upon the class, that
the tartar emetic ointment used in these countries is too strong, the conse-
quence of which is an eruption of large pustules, which are excessively painful^
and often accompanied with such disturbance of the constipation as amounts to
symptomatic fever. In fact, tartar emetic ointment of the ordinary strength
produces so much irritation, that few patients will submit to it long. The
form which I recommend you to employ is the following: — Take seven drachms
of prepared lard, and instead of a drachm of tartar emetic, which is the usual
quantity, take half a drachm, directing in your prescription, (this is a point of
importance,) that it be reduced to an impalpable powder^ and you may add to
it what will increase its action, one drachm of mercurial ointment. This pro-
duces a crop of small pustules, which give buthttle pain and are easily borne?
and the counter-irritation may be kept up in this way for a considerable time,
by stopping for a few days, until the eruption fades away, and then renewing"
the friction. I have often seen the utility of this remedy exemplified in cases
of chronic gastritis, where the symptoms of gastric irritation, which had sub-
sided under the employment of friction with tartar emetic ointment, returned
when it was left off, and again vanished when it was resumed. The case of the
celebrated anatomist, Beclard, furnishes a very remarkable proof of the value
of a well-regulated diet and repeated counter-irritation in the treatment of this
disease. While he was engaged in the ardent prosecution of his professional
studies he got an affection of the stomach, which he considered to be a chronic
gastritis, and immediately put himself under a strict regimen, using at the same
time repeated counter-irritation. He kept up the counter-irritant plan for a
considerable length of time, for he found that, when he discontinued it, the
gastric symptoms had a tendency to return. In this way he got completely rid
of the disease. Several years afterwards he died of an attack of erysipelas; and
on opening his stomach, the cicatrix of an old ulcer was discovered in the vi-
cinity of the pylorus, which was exactly the spot to which he had referred his
pain during the continuance of his gastric affection.
. Gentlemen, there is perhaps no science in which the motto ^^ medio tutlssi^
mus ibis" is of more extensive application than in medicine. Some physicians
on the continent, particularly the disciples of Broussais, having repeatedly wit-
nessed the advantages of strict regimen and local depletion in chronic gastritis^
have pushed this practice too far. They seemed to forget that the system re-
quires support and nutrition, which can be effected only through the agency
of the stomach; they saw the evils whicli result from the use of stimulating food
in cases of chronic gastritis; and looking to these alone, they ran into the op-
posite extreme, the consequence of which was, that they kept their patients so
long upon low diet, that they actually produced the very symptoms v/hich they
wished to remove. The patients became dyspeptic from real debility of the
stomach and the whole frame. You remember a general law of pathology to
which I have alluded on a former occasion, and which I shall again mention, as
it illustrates this point, namely, that opposite states of the economy may be ac-
companied by the same symptoms. Thus we observe, that palpitation may
depend on two different causes — on a sthenic or asthenic condition — on the
presence of too much or too little blood in the heart. Now, it frequently hap-
pened that patients labouring under chronic gastritis, and who had been treated
for a long time after the strict plan adopted by the Broussaists, finding them-
selves not at all improved, went to other physicians who had different views,
and were rapidly cured, by being put upon a full nutritious diet. In this way
numerous cases, which water diet and depletion had only aggravated, were re-
lieved, and the consequence was, that a mass of facts was brought forward and
pubhshed, not long since, by a French author, against the antiphlogistic treat-
ment of dyspepsia and chronic gastritis. It must be stated, however, that the
492 QUARTERLY PERISCOPE.
Gases which he published were chiefly those in which the depleting system
had been carried to excess, and that they cannot, therefore, be received as
proofs of the value of a stimulating diet in the treatment of chronic inflamma-
tion of the stomach. Bear this in mind; the sooner you can put your patient
on a nutritious diet the better will it be for him. It would be absurd to keep
a patient for many months, as the Broussaists have done, on slops and gum-
water. It will be necessary for you to feel your way and improve the diet gra-
dually. Commence by giving a small quantity of mild nutritious food; if your
patient bears it well, you can go on; if the gastric symptoms return you can
easily stop. If a small portion of the milder species of food rests quietly on
the stomach, you may increase it the next day or the day after, and thus you
proceed to more solid and nutritious aliment, until the tone of your patient's
stomach regains the standard of health. Never lose sight of this fact, that you
may have a case of dyspepsia depending on a chronic gastritis, in which, though
you remove the injiammation by a strict antiphlogistic treatment, you may not
by this remove the dyspepsia; and if you continue to leech, and blister, and
starve your patient after the inflammatory state he removed, you will do great in-
jury. Such a patient, falling into the hands of another practitioner who treated
him on a different system, might be relieved, and his case quoted against you
and your treatment, though this, at the commencement, was judicious and
proper.
With respect to internal remedies, the school of Broussais think that there is
DOthing required but cold water and gum. This is going too far. In a former
lecture I have drawn your attention to the fact, that in the treatment of acute
inflammation there is a point where antiphlogistics should cease, and where
tonics and stimulants are the most efficient means of cure. Of this fact the dis-
ciples of Broussais appear to be ignorant, and they consequently declared
against every remedy for chronic gastritis except leeches and cold water. Now
is this right? I think not. We find that, in all cases of gastric inflammation, a
change in medication seems to be useful at some period of the disease, that is,
a change from antiphlogistics to tonics and stimulants, and I believe that in cases
of chronic gastritis these remedies may be used w'lXh very great advantage,
having, of course, premised depletion and counter-irritants. I believe too,
that most of the remedies, which we see every day unsuccessfully employed,
would have acted beneficially, if the preparatory treatment which I have men-
tioned had been adopted. Among the best remedies of this kind is the oxide
of bismuth; I have seen more benefit from the use of this than of any other
medicine, after the treatment already alluded to. Generally speaking, the list
of internal remedies for chronic gastritis is very small, but after the use of anti-
phlogistics you may prescribe the vegetable tonics and oxide of bismuth witii
advantage. The most decidedly valuable remedy, however, in the after stage
of a chronic gastritis is tlie acetate of morphia, which I am convinced has a
very powerful effect in allaying chronic irritation of the stomach. Dr. Bardsley
of Manchester, in one of liis published works, entitled " Hospital Facts and
Observations," adduces man}'- cases of gastric irritation which were completely
relieved by the use of this remedy, and I am perfectly satisfied of the truth of
his statements. It may be said that Dr. Bardsley's cases were only instances of
dyspepsia. But as his cases were extremely numerous, some of them of long
standing, and the symptoms very severe, the great probability is, that some of
them at least must have been cases of chronic gastritis. I know vei'yfew books,
the perusal of which I would more strongly recommend to you, than Dr.
Bardsley's accurate and instructive work. The great besetting sin of medical
writers is, that their statements of successful practice are grounded on a very
limited number of cases, or that, in publishing the result of their practical
investigations, they only give their successful cases, and leave out those in
which the treatment recommended has been found ineflficacious. Yet this is a
circumstances which should never be neglected. If a man declares that he has
discovered a cure for gastritis, or dyspepsia, and brings forward one hundred
Practice of Medicine. 493
cases in which the remedy has done good, the statement is still unsatisfactory
and insufficient, because there may be one thousand cases in which it has totally
failed. Unless he comes forward and gives both his successful and unsuccess-
ful cases, of what value are his statements? Dr. Bardsley, with the candour
and good sense which always characterize the philosophic inquirer, gives the
result of all his cases, forms them into tables, and then leaves his readers to
judge for themselves. From an inspection of these tables, you will be con-
vinced of the efficacy of acetate of morphia in the treatment of chronic gastri-
tis. I have been in the habit of using it with the most gratifying results after
leeching, regulating the diet, and paying proper attention to the state of the
bowels. There are some forms of the disease in which it is more useful than
others. The particular form in which it proves most serviceable, is where
there is a copious secretion of acid from the stomach, (that form in which all
kinds of alkahes have been exhibited,) where severe pain and constant acidity
are the prominent symptoms. Here I have seen the acetate of morphia act ex-
ceedingly well. You may begin with one-twelfth of a grain, made into a pill
with crumb of bread, or conserve of roses, twice a-day; the next day you may
order it to be taken three times, and you may go on in this way until you make
the patient take from half a grain to a grain and a half in the twenty -four hours.
I shall here mention the circumstances of a case, which I do not mean to bring
forward as an instance of cure, but as an illustration of the extraordinary power
which acetate of morphia possesses in relieving gastric irritation. A gentle-
man of strong mind and highly cultivated intellectual powers, which he kept
in constant exercise, got a severe chronic gastritis: his appetite completely de-
clined; he had frequent vomiting of sour matter; foetid eructations; and such
violent pain in the stomach, that he used, when the attack came on, to throw
himself on the ground, and roll about in a state of indescribable agony. He
applied to various practitioners, had several consultations on his case, and the
opinion of the most eminent medical men was, that he had incurable cancerous
disease of the stomach. These symptoms continued for several years, but for
the last two or three years they were quite intolerable. He had repeated cold
sweats, vomited every thing he took, even cold water, was reduced to a skele-
ton, and led a life of complete torture. Under such circumstances he tried, for
the first time, by my advice, the acetate of morphia. He tried it first in doses
of one-tenth of a grain three times a-day, and experienced the most unexpected
relief. On the third day all his bad symptoms were gone. He had no pain,
no vomiting, no sweats; his spirits were raised to the highest state of exhilira-
tion, and he thought himself perfectly cured. He went out in the greatest joy,
visited all his friends, and told them that he had at last got rid of his tormenting
malady. In the evening he joined a supper party, indulged pretty freely, and
next morning had a violent h^matemesis, to which he had been for some time
subject. All his old symptoms again made their appearance. He again had
recourse to the acetate of morphia, and again immediately experienced relief,
but the vomiting of blood again returned, so that he discontinued the remedy.
This gentleman is now in the enjoyment of good health. He regulated his
diet, left off ail medicine by the mouth, used warm water injections, and thus
recovered from his supposed cancer.
I do not bring this case forward as an instance of the curative effect of ace-
tate of morphia, but as an instance of its povi^erful effect in allaying gastric irri-
tation. 1 could adduce other cases in proof of its value in the treatment of the
after stage of chronic gastritis, and particularly of that form in which pain and
acidity are the prominent symptoms; but T perceive my time has nearly ex-
pired. At my next lecture, I shall give some other particulars connected with
this subject, and then proceed to the consideration of diseases of the small in-
testine.
In speaking of the employment of counter-irritation in cases of chronic gas-
tritis, I forgot to mention the use of friction with croton oil, which has been
found beneficial in many cases of chronic inflammation. It has been exten-
No. XXVIII.— 'August, 1834. 42
494 QUARTERLY PERISCOPE.
sively used by many practitioners in the treatment of chronic affections of the
joints, and in various forms of pulmonary disease; and I have employed it my-
self in some cases of chronic gastritis with benefit. I cannot say that the cases
in which I have used it presented all the symptoms of chronic gastritis, but they
were certainly cases of chronic gastrodynia, with severe local pain, nausea, and
loss of appetite. It is an excellent counter-irritant, and gives very httle pain.
The mode in v/hich I employ it is this, — take a few drops of croton oil, five or
six, for instance, drop them on the epigastrium, and rub them in with a piece
of lint or bladder, interposed between your finger and the skin, and the next
day you have an eruption of small papuise, which you can increase at will.
There is one interesting circumstance connected with the use of croton oil
frictions, which you should be made acquainted with. The liabihty to produce
counter-irritation, seems to depend upon the absorption or non-absorption of
the croton oil; if it be absorbed it will purge, but if it be not it will produce
counter-irritation. In cases of this kind, therefore, where it produces the ne-
cessary degree of irritation in the skin, the chances are, that it will not act dis-
agreeably by bringing on catharsis. I have only seen one case where there
were both the eruption and catharsis. This was a gentleman who had lately
suffered from dysentery in warm climates.
1 may also mention, that in convalescence from an attack of chronic gastritis,
you must pay great attention to diet for a long time, because there is no affec-
tion of any organ in the body, in which an error in diet so rapidly induces a
return of the original symptoms, as in disease of the stomach, while each re-
turn of the disease renders the attack more dangerous and unmanageable, until
at last disorganization takes place. — Ibid.t Feb. 1st and 8ih, 1834.
31. On the Use of Blisters. By William Stokes, M. D. [Extracted from
Lectures on the Theory and Practice of Medicine, delivered at the Medical
School, Park street, Dublin . ] — It is a great error to think that blisteri ng is a matter
of course in inflammatory diseases, or that the proper period for their applica-
tion should not be carefully marked. It is a common idea, that if a blister does
no good it will do no harm; that it is probable some benefit may result from its
employment, and that you may try it at all events. I need not tell you that all
this is wrong, and that we must be guided by exact principles in this as well as
in every other part of practical medicine. I am afraid there is a great deal of
loose reasoning and empirical practice connected with this subject, even at the
present day. Here is the general rule by which you should be invariably guided.
No matter what kind of disease you have to deal with, if it be inflammatory,
blistering in the early stage of it is decidedly improper. I might amplify this
rule, and say, that if the disease be inflammatory and in its early stage, or, if,
under such circumstances, the symptoms require the general or local abstraction
of blood, blisters cannot be used with propriety. The truth is, that many per-
sons take a very limited view of this subject; they look upon blisters as merely
revulsive agents, which, by their action on the surface, have the property of di-
minishing visceral inflammation. This I am willing to allow is true to a certain
extent, but there is abundant evidence to prove, that blisters have sometimes a
direct stimulant effect on the suffering organ. That this occasionally occurs has
been established by many facts in medicine; and 1 have not the slightest doubt,
that the apphcation of a blister over an organ in a state of high inflammatory ex-
citement will certainly be productive of injurious consequences. But if you
apply them at the period when stimulation is admissible and useful, (and there
will always be such a period in every inflammation,) you then act on just prin-
ciples, and will generally have the satisfaction of finding your practice success-
ful. The greatest empiricism is sometimes practised in the application of blis-
ters to the head in acute inflammation of the brain. You will see, in Mr. Porter's
admirable work on the Pathology of the Larynx, how strongly he is opposed to
the early use of blisters in acute laryngitis. Dr. Cheyne, also, may, among
many others, be quoted in support of this doctrine.
Practice of Medicine. 495
If there is one system more than another likely to be injured by early blis-
tering-, it is the digestive. Broussais says, that blisters should not be applied
in any of" the stages of acute gastro-enteritis, and that in the early stage their
application is the very height of malpractice. I do not go so far as to say that
they should not be applied in any period of the disease, for when the skin is
cool, the pulse lessewted, and the local inflammation so far reduced as not to re-
quire the abstraction of any more blood, I think you may employ them with very
considerable advantage. I shall again return to the subject of blisters; and will
for the present merely remark, that blistering is almost always mismanaged, in
consequence of persons who apply them being ig-norant of their stimulating ef-
fects on organs. They generally allow them to remain on too long, and the
consequence of this is often violent excitement of the organ over which they
are applied, great constitutional irritation, strangury, and bad sores. The best
mode of using them is to direct the person who prepares the blister to cover it
with a piece of silver-paper before it is applied, and having put it on with
the paper next the skin, to let it remain until a decided sense of smarting is
produced, when it should be immediately removed. By adopting this plan,
you will save yourself and your patient a great deal of inconvenience; you will
have no strangury, stimulation of the whole economy, or excessive local irrita-
tion, and the inflamed surface will heal kindly. The mode, (too often prac-
tised,) of applying a blister sprinkled all over with an additional quantity of
powdered cantharides, and leaving it on for twelve, twenty-four, or even thirty-
six hours, particularly in the case of females, is nothing better than horse doc-
toring. During a seven years' experience in the hospital at Tours, Brettonneau,
by attending to this principle, never had a case followed by these troublesome
symptoms, and yet he never failed in producing the necessary degree of counter-
irritation. The active principle of cantharides, being soluble in oil, exudes
through the silver-paper in sufficient quantity to produce the necessary effect
on the skin, without exposing the patient to the risk of having too much irri-
tation excited by the direct application of the blistering plaster to the cutaneous
surface. — Ihid^ January ^Sth^ 1834.
32. On Delirium Tremens. [ExtractedfromDr. Stokes's Lectures on the Prac-
tice of Medicine.] — You have seen cases of delirium tremens, but you are not,
perhaps, aware that it arises under two opposite classes of causes. In some
cases, a patient who is in the habit of taking wine or spirituous liquors every
day in considerable quantities, meets with an accident or gets an attack of fever.
He is confined to bed, put on an antiphlogistic diet, and in place of wine or
whiskey-punch gets whey and barley-water. An attack of delirium tremens
comes on, and symptoms of high cerebral excitement appear. Another person,
not in the habit of frequent intoxication, takes to what is called a fit of drink-
ing, and is attacked with delirium tremens. In the first case the delirium arises
from a want of the customary stimulus, in the second from excess. In each
the cause of the disease is different; and consequently, with this view of the sub-
ject, it would be a manifest departure from sound practice to treat both cases
in the same way. Yet, I believe, this error is frequently committed, even by
persons whose authority is high in the medical world, and is part of a system
not yet exploded, — the system of prescribing for names and not for things. The
patient is treated for a disease which has been called delirium tremens, the
present symptoms are only attended to, and the cause and origin of the aflTection
are overlooked. What are the true principles of treatment?— In the first va-
riety, where the delirium is produced by a want of the customary stimulus, there
is no doubt that patients have been cured by the administration of the usual sti-
mulants, by giving them wine, brandy, and opium. Indeed this seems to be the
best mode of treating this form of the disease. But is it proper or admissible
in the second variety, where the diliriura is caused by an occasional excess in
the use of ardent spirits? — 'Certainly not. Yet what do we find to be the ordi-
nary practice in hospitals when a patient is admitted under such circum»
496 QUARTERLY PERISCOPE.
stances? — A man, who has been attacked by delirium tremens after a violent de-
bauch, is ordered a quantity of porter, wine, brandy, and opium; and the
worse he gets, the more is the quantity of stimulants increased. Now this prac-
tice seems to me as ridiculous as the old principle of treating a case of hydro-
phobia with the hair of the dog that bit. Let us consider what the state of the
case is. A large quantity of stimulant liquors have been taken into the stomach,
the mucous surface of that organ is in a state of intense irritation, the brain and
nervous system are in a highly excited condition from the absorption of alcohol,
or in consequence of the excessive sympathetic stimulation to which they have
been subjected. Ar'^ we to continue this stimulation? — I think not. What
would be the obvious and natural result? — Increased gastric irritation, encepha-
litis, or inflammation of the membranes of the brain. The supervention of in-
flammatory disease of the brain in delirium tremens is not understood by many
practitioners, and they go on administering stimulant after stimulant, totally un-
concious that they are bringing on decided cerebral disease. I have witnessed
the dissections of a great many persons who died of delirium tremens, and one
of the most common results of the dissection was, the discovery of unequivocal
marks of inflammation in the brain and stomach. Broussais considers all such
cases as merely examples of gastritis, and ridicules British practitioners for in-
venting **a new disease?" but in this he is certainly wrong, for there have been
several cases in which no distinct marks of gastric inflammation could be dis-
covered. In all cases, however, where the delirium supervenes on an exces-
sive debauch, there is more or less of gastritis; and though it may occasionally
happen, that a patient under such circumstances may recover under the stimu-
lant treatment, yet I am convinced that the physician will very frequently do
harm by adopting it.
This complication of delirium tremens with gastritis is also exceedingly cu-
rious in another point of view, as it illustrates how completely the local symp-
toms are placed in abeyance, and, as it were, lost during the prevalence of
strong sympathetic irritation. The patient's belly will not be tender; the tongue
may not be red; the symptoms present may be indicative of a mere cerebral af-
fection, and yet intense gastric inflammation may be going on all the time, and
all the appearances of cerebral disease be quickly removed by treatment calcu-
lated to subdue a gastritis. Is this all theory? No; for we have practised on
this principle with the most extraordinary success in the Meath Hospital. We
have seen cases of violent outrageous delirium subside under the application
of leeches to the epigastrium, and iced water without a single drop of lauda-
num. I beg of you, if you meet with any cases of delirium tremens under such
circumstances, to make trial of this mode of treatment, and record its effects,
for it is important that they should be more extensively known. I have seen
the whole train of morbid phenomena, the delirium, the sleeplessness, the ex-
cessive nervous agitation, all vanish under the application of leeches to the epi-
gastrium. In some cases where after the sleeplessness and delirium were re-
moved by this practice, and the tremors alone remained, we have again applied
leeches to the epigastrium, and succeeded in removing the tremors also. On
the other hand, where a stimulant plan of treatment was employed, and the pa-
tients died, we have most commonly found inflammation in two places, in the
stomach, or in the brain or its membranes. The rule, then, is this, — in a case
of delirium tremens from the want of a customary stimulus, use the stimulant
and opiate treatment; but when it comes on after an occasional violent debauch,
such remedies must be extremely improper. Adopt here every thing calculat-
ed to remove gastric irritation. We have facts to show that most decided ad-
vantage may arise from the application of leeches, even where the symptoms
of gastritis are absent. — Ibid.
33. On Mammary Abscess. — Dr. Beattt, of Dublin, in a paper in the Dublin
Medical Journal^ for January last, extols the controlling power of tartar emetic
in this aflfection. On the accession of inflammatory symptoms in the breast, after
Practice of Medicine. 497
purging" the patient, he administers the tartar ennetic in doses of one-sixteenth
of a grain, repeated every hour, so as to induce shght nausea. If vomiting is
induced, the medicine is to be omitted for an hour or two, and its use then re-
commenced at longer intervals. In ordinary cases, after twenty-four hours, the
pain and fever. Dr. B. says, are usually mitigated, and the breasts are smaller
and softer. If these effects are not produced in that time. Dr. B. doubles tlie
dose, provided the stomach will bear it, and it rarely happens that it will not,
for Dr. B. says, that he has observed that in those cases which do not yield rea-
dily, the stomach is very patient of the medicine.
34. On the Treatment of For n go Decalvans by Solution of Tartar. By Dr. H.
Beauchamp. — Few affectioHs more frequently buffie the skill of the medical
practitioner, or give employment to the nostrum monger, than porrigo decal-
vans. Our author has some doubt as to the propriety of placing the affection in
question in the genus porrigo, but does not stop to offer a new arrangement.
He was led to try the effect of tartrite of antimony in this disease, from a con-
versation with his friend Dr. Carter, an army-surgeon of considerable experi-
ence, who had often succeeded with this remedy in restoring the growth of
hair that had fallen off in consequence of acute diseases, the use of mercur^v,
&c. The strength of the solution was five grains to an ounce of distilled water.
Shortly after this conversation a young lady apphed to Dr. B. complaining that
her hair fell off from a particular spot of her head. On examination, this part
was found to be slightly red, unlike what generally happens, and therefore he
thought it proper to apply leeches in the first instance. After the second ap-
plication the hair began to grow, and there was no necessity for the antimony.
After several months the lady returned, with another bald part; but this time
the skin was pale. Nevertheless he applied leeches, without any good effect.
Afterwards he had recourse to the antimonial solution, which was applied three
times a day. The hair grew again, and of the same colour as the rest of the
hair.
The next case was that of a young lady from whose head the hair first fell off
in spots, but in the course of five or six years, half the head had become bald,
in spots, from the size of a sixpence to that of a half-crown. The antimonial
solution was then employed, having the remaining hair shaved off. By mistake
the solution was made too strong% and brought out a crop of pustules. When
these had healed a soft down of hair was perceptible on the affected parts, but
of a lighter colour than the remaining hair. The head was again shaved, and
the solution of proper strength was ordered. But the anxious mother again ap-
plied a strong solution, v/hich brought out a crop of pustules not only on the
head, but over nearly the whole body, accompanied by febrile action requiring
antiphlogistics. The fever subsided, and the pustules disappeared, except from
the head, where the pustules coalesced and formed an immense scab, not un-
like those of tinea capitis. The lady bathed in the sea during the summer
months, had the head repeatedly shaved, and subsequently recovered com-
pletely, having the head covered with a uniform growth of hair.
Even these few instances deserve the notice of the profession, and further
trial of the remedy. — Med. Chlrurg. Rev. from Dublin Journ. No. XII.
35. Neuralgia.— -M.. Roux, in a memoir in the Bulletin Generate de TJierapeu-
tiquet for 1832, strongly recommends the external use of the following lotion in
neuralgia: — R. Distilled cherry-laurel water, §iv. ; Sulphuric ether, 5J.; Extr.
belladonna, ^ij. M.
36. Hydrophobia. — M. Buissoif has written to the Paris Academy of Sciences,
to claim a paper, which he forwarded so far back as 1823. The paper contain-
ed a case of hydrophobia, which was his own; the following is the report of it.
He had visited a woman, who had been suffering under symptoms of hydro-
phobia for three days. She had constriction of the throat, inability to swallov/j
42*
498 QUARTERLY PERISCOPE.
abundant secretion of the saliva, and foaming- at the mouth. She had been bit
by a mad dog forty days previously; she was bled, and died shortly afterwards.
M. Buisson, whose hands were covered with blood, incautiously cleansed
them with a towel which had been used to wipe the mouth of the patient. He
then had an ulceration upon one of his fingers, yet thought it sufficient to wash
off the saliva that adhered with a little water. The ninth day after he was sud-
denly seized with a pain in his throat and eyes. The saliva was continually dis-
charging into his mouth; the impression of a current of air, the sight of brilliant
bodies, gave him a painful sensation; his body appeared to him so light, that he
felt as though he could leap to a prodigious height, and experienced a wish to
bite, not men, but animals and inanimate bodies. Finally, he drank with diffi-
culty, and the sight of water was still more distressing to him than the pain in
his throat. These symptoms recurred every five minutes, and it appeared to
him as though the pain commenced in the aflTected finger, and extended thence
up to the shoulder.
From the whole of the symptoms, he judged himself affected with hydropho-
bia, and resolved to terminate his life by stifling himself in a vapour bath. Hav-
ing entered one for this purpose, he caused the heat to be raised to 42°, (107°
36' Fah.) when he was equally surprised and delighted to find himself free from
all complaint. He left the bathing-room well, dined heartily, and drank more
than usual. Since that time he has treated in the same manner more than eighty
persons bitten, in four of whom the symptoms had declared themselves bad,
and in no case has he failed, except in that of one child, seven years old, who
died in the bath. The mode of treatment he recommends is, that the person
bit should take a certain number of vapour baths, (commonly called Rousseau,)
and should induce every night a violent perspiration, by wrapping himself in
flannels, and covering himself with a feather bed, the transpiration to be fa-
voured by drinking plentifully of a warm decoction of sarsaparilla. M. Bouisson
declares himself so convinced of the efficacy of this treatment, that he will suf-
fer himself to be inoculated with the disease, and as a proof of the utility of co-
pious and continued perspiration he relates the following anecdote.
A relative of the musician Gretry was bitten by a mad dog, with many other
persons, who all died of hydrophobia. For his part, feeling the first symptoms
of the disease, he took to dancing night and day, saying that he wished to die
gaily. He recovered.
M. Buisson also draws attention to the fact, that the animals in whom this
madness is most frequently found to develope itself spontaneously, are dogs,
wolves, and foxes, which never perspire.
37. Tfacheotomy in the Last Stage of Croup. — M. Trousseatt, in an interest-
ing paper on this subject, in the second number oi ihQ Journal des Connaissances
Midico-Chirurgicales, states that there has come to his knowledge twenty-one
cases of croup in which tracheotomy was performed in the last stage of the dis-
ease, and seven of them were saved, viz. five by M. Bretonneau, one by M.
BuUiard, and one by himself. As in those twenty-one cases the operation was
not performed until death seemed inevitable, and there remained no other
means of safety, he thinks that it is the duty of a conscientious practitioner not
to neglect a dernier resource, which finally leaves still some chance. The ope-
ration is easily performed, and rarely dangerous, he adds, since of the twenty-
one cases operated on, not one experienced the least accident.
OPHTHALMOLOGY.
38. Observations and Reflexions upon Amaurosis^ communicated by M. A. Beh-
TON, First Assistant Surgeon to the Municipal Guard of Paris. — Richter assigns
three orders of causes as operating in the production of amaurosis. The first
Ophthalmology, 499
comprehends those which determine a plethora or turgescence of the sanguine
vessels of the brain, retina, and optic nerve, which state he supposes produces
a certain degree of compression of these organs. The second includes those
causes which operate in debilitating the economy of the organ of vision alone.
There is nothing, according to this author, that tends more certainly to enfeeble
the forces of these organs than the fatigue incident to their exposure to bril-
liant objects, (the reflexion from a bright light for instance;) the absolute fixed-
ness of vision necessary in the examination of minute objects, operates in the
same way. He cites a case of a person, who, in being obliged to pass over a
portion of country covered with snow, found himself suddenly attacked with
amaurosis, and another in which the disease was occasioned by the patient
having been exposed to the reflexion from a brilliant flash of lightning. Pro-
fessor Beer is also of opinion that this class of causes operate in producing the
disease. In the third order of causes are ranged all those irritations which affect
in an inexplicable manner the optic nerve, rendering it insensible to the im-
pression of light. Several of these irritations are supposed to have their seat in
the abdominal viscera, whence they radiate, affecting the eyes sympathetically.
In the true and simple amaurosis of Beer, we have only the vital properties of
the optic nerve and retina affected, and the affection depends either upon an
excess of vitality, or better, of sensibility of these nervous portions; or upon a
debility of this vitality or sensibility. The first variety of this species of amau-
rosis always depends upon a determination of blood to the head and eyes,
which exercises a manifest influence over the primary formation of the disease.
All those circumstances, which tend to produce either general debility or de-
bility of the eyes alone, are the causes more or less determinant of the second
species. In the interesting clinical lectures of Dr. Licbel, published in the Lan-
cet, (No. 64,) we are told, "that all cases of amaurosis, which are not symptoma-
tic of the disease of some other organ than that of vision, (that is to say, that
are not sympathetic,) may most generally be reduced to two classes, the one in
which the disease depends upon the existence of an irritative or sanguineous
congestion, or even an inflammation, either of the choroid membrane, the re-
tina, or optic nerve; the other, where it is brought about by a paralysis more or
less complete of the last mentioned nervous divisions." These explanations, and
those given by most writers upon diseases of tlie eye, relative to the etiology
of the disease, differ but little from each other. Considering them then, as be-
ing the most generally received as correct, we shall go on to the consideration
of the following cases, and try to discover to which order of causes they are
most strictly to be referred.
Observation 1. — -The subject of this case was a young woman, aged twenty-
four years, of a good constitution, possessing no traits of the lymphatic tempera-
ment, perfectly regular, enjoying at the time excellent health, and who had,
moreover, never suffered from any indisposition. Jumping up suddenly one
night, she placed herself at a window looking into a street, in which there hap-
pened to be a very bright light. All at once she experienced a very extraordinary
sensation in the right eye, and was struck with surprise and terror upon finding
that in a few moments the lid of that side involuntarily closed itself, and that
vision in that eye was very imperfectly performed. Leeches, blisters, irritating
frictions upon the temples, were all prescribed, but without producing the
slightest amelioration in the symptoms. I was not called to the patient until
about the fifteenth day after the occurrence of the attack. At that period the
right lid was incapable of any motion whatsoever, and fell down over the eye
as soon as the force applied to raise it was removed. It nevertheless retained
its sensibility, and the slightest touch upon its surface was perceived. The eye
looked outwardly, and its pupil was dilated anid but slightly contractile. In the
other eye, which was, moreover, in a perfectly physiological condition, vision
was performed in a very imperfect manner, objects appearing as if seen through
gauze. When examined with both eyes every thing appeared double. For some
days past she had suffered from a slight cephalalgia located near the right co-
500 QUARTERLr PERISCOPE.
ronal region. The double vision resulted in this case from a deviation of the
visual axis, and this deviation was dependent upon the disease being- confined
to but one eye. Richter considers strabismus as being the most certain diagnos-
tic in amaurosis. Beer, who also considers this phenomenon as being usually-
present in similar circumstances, explains it by observing, that it results from
the eye of the patient never resting or fixing itself upon an object. It seems to
me, however, that we may, with at least as much propriety, refer the cause to
the disease itself, or to an extension of it: in the first place, this phenomenon is
never observed except in those cases in which amaurosis is incomplete, where
certain portions only of the retina, (particularly the median,) have been at-
tacked with paralysis. The other portions of this nervous expansion, still re-
maining sensible to the influence of the light, will instinctively turn towards the
field of vision, in order to receive the impression of the luminous rays. Accord-
ing to another hypothesis, the strabismus results from a paralysis of some motor
muscle of the eye, whereby a want of antagonism takes place. We can as easily
conceive how one of the straight muscles may become paralyzed, as that the
levator of the lid should lose its power of contracting. However this may be, I
am of opinion that the preceding case should be referred to the second division
of Eichter. I recollect, in fact, similar cases that he has cited? among others,
that of a person labouring under ecstasy, who, upon being exposed to the re-
flexions of light from the disc of the moon was attacked v/ith amaurosis. Con-
sidering the youth and strength of the patient, as well as the insufficiency of the
two or three previous leechings, I insisted upon a repetition of the sanguine
emissions, and also the exhibition of revulsive remedies addressed to the intes-
tinal canal. Having obtained no amelioration in the symptoms whatever towards
the end of the eighth day, I thought it adviseable to change the plan of treat-
ment, and accordingly prescribed such remedies as promised to stimulate or re-
excite the sensibility of the nervous portions of the eye, and irritating frictions
to the temples, forehead, and even to the lid itself, were employed? she v/as
also ordered to take the pills of Meglin, to have a large blister applied to the
nucha, and to take a vomit, (a remedy by the by I should have feared to pre-
scribe had I supposed that the affection depended upon plethora of the vessels,
as it would in such a case have proved hurtful, by determining a greater quan-
tity of blood to the part diseased.) In less than a week a remarkable improve-
ment in all the symptoms manifested itself; the lid opened of its own accord,
and allowed the lower portion of the pupil to be seen, and the affected eye dis-
tinguished a little more clearly objects that were placed before it. She remain-
ed in this improved condition for some time, without any change for the better,
and the progress towards a cure seemed to have stopped at this point. I deter-
mined after some days to employ the strychnine; I administered it at first in the
dose of a fourth of a grain once a day, and augmented it gradually until she
took half a grain night and morning. In ten or twelve days she was completely
cured, the visual axes, (which had been daily approaching each other nearer
and nearer,) became again perfectly parallel, and there remained neither in the
appearance of the eye itself, nor in the performance of its functions, a single
trace by which one would be led to suspect the previous existence of the
disease.
Observation 2. — The second observation resembles very much the preceding,
and was taken about the same time by Dr. Bodson, a relative of mine. The pa-
tient, a woman aged about fifty years, who had had several children, and with
■whom the critical period had passed only a few years, was attacked with amau-
rosis in both eyes, which came on gradually. When Dr. Bodson was consulted
the disease had existed thirty-five days. The lids were closed and paralyzed,
the right pupil slightly dilated, and vision imperfect, (objects appearing as if
seen through a cloud.) The sight appeared much more confused on the side of
the dilated pupil. She had been bled and leeched three times, twice behind
the ears, and once upon the internal superior portion of the thighs. She had
also used the foot-bath containing mustard, and had taken purgative medicines.
Surgery. 501
No benefit whatsoever had resulted from this treatment. M. Bodson ordered
the superior coronal region to be shaved and blistered, and the other remedies
to be continued. From the fourth day after the application of the blister, the
lids began to open of themselves, though to no great distance, but several days
having elapsed without further improvement, the purgative pills were replaced
by some composed of the alcoholic extract of the nux vomica. From this pe-
riod a daily improvement in all the symptoms took place, and towards the end
of the third week a complete cure was effected. The lids having in fact reco-
vered all their former facility of movement, and the sight becoming so perfect
that the patient was enabled to resume her occupation with the needle. It
would be useless for us to endeavour to demonstrate by means of new details,
that which seems evidently to exist from facts already given, viz. that the two
preceding cases of amaurosis are not similar in their character to those which
depend upon a visceral affection, (sympathetic amaurosis;) nor to those which
result from a congestion, irritation, or even an inflammation of the nervous or-
gans essential to the eye, but that they depended upon a paralysis of the nerves,
or nervous membranes of the organs of vision; a paralysis which, according to
oculists, attacks in a manner more or less complete the optic nerve, the retina,
or even the choroid coat itself. Let us observe that the trifacial nerve has not
been mentioned, notwithstanding the experiments of Professor Magendie, (the
results of which are published in his Precis de Physiologic,) show, 1st, that the
winking of the lid depends in part upon the facial nerve, and partly upon a
branch of the fifth pair, and that it ceases, or but very rarely takes place, after
a division of the latter, and that it ceases entirely alwaj'^s when the facial nerve
is divided; 2d, that the section of the optic nerve destroys vision entirely, and
that a division of the fifth pair does not entirely destroy the sensibility of the re-
tina, but that a small portion of it remains. From these physiological facts may
we not draw the inference, that branches of the fifth pair are the nerves affect-
ed in incomplete amaurosis, if not always, at least in those cases complicated
with paralysis of the eyelids, as was the case in the two preceding obser-
vations?
39. Nutrition and Diseases of the Humours of the Eye. — M. Boubjot, in a
memoir communicated to the Royal Academy of Medicine, has endeavoured to
show that the formation and renewal of the humours of the eye are due to the
action of endosmose and exosmose. The basis of his theory is, that the humours
of the eye, having different densities, and being separated by delicate and po-
rous animal tissues, a double current of endosmose and exosmose takes place.
He believes that the aqueous humour passes by endosmose through the cap-
sule of the crystalhne; that the humour of Morgagni passes through the poste-
rior parietes of the crystalline capsule in the meshes of the vitreous humour;
and that this last finally penetrates the parietes of the veins which ramify over
the surface of the hyaloid membrane. Finally, he applies this theory to the ex-
planation of the diseases of the humours of the eye, to different cataracts, for
example, that the density of these humours vary, consequently their propor-
tions, their circulation changes, and different cataracts form. — Archives Gene-
rales, Oct. 1833.
SURGERY.
40. Hydrocele cured by Tincture of Iodine. — M. P. Record, Surgeon to the
Hupital des Veneriens, has employed the tincture of iodine with success in five
cases of hydrocele independent of any syphilitic cause. The tincture of iodine
is diluted with distilled water, and applied to the tumours by aid of compresses
imbibed with it, and in which the scrotum is enveloped. M. Record employs
the tincture in four different degrees of concentration: — 1st. Tinct. iod. 5j.;
Aq. distill. §iij.; 2d. Tinct. iod. ^ij.; Aq. distill. §iij.; 3d. Tinct. iod. ^iij.; Aq.
502 QUARTERLY PERISCOPE.
distill, ^iij.; 4th. Tinct. iod. ^vj.; Aq. distill. §iij. In subjects whose skin is very
delicate and epidermis thin, the last formula is employed. When there is less
sensibility and some hardness of the tissues, the other formulae are employed pro
re nata. For the medicine to produce its beneficial effects, the patients must ex-
perience a rather vivid but supportable sensation of heat; and without there being
burning" or vesication, the skin of the scrotum must become brown, or pass into
brownish-red, the epidermis becoming" like parchment, and forming scales that
are detached leaving beneath them a sort of thick transpiration still without vesi-
cation. So long as these results are not obtained the dose of the tincture of
iodine must be increased, the quantity of distilled water remaining tiie same;
but when these effects have resulted, tiie tincture of the same degree of concen-
tration must be continued by steeping compresses in it and renewing them
twice a day. If pain supervene, the application is suspended for a few days,
and its use resumed until the disappearance of the tumour. — Journal des Con-
Qiaissances Med. Chirurg. Jan. 1833.
41. Resection of Bones in Ununited Fractures. — Surgeons have long enter-
tained an opinion with regard to the resection of bones in cases of ununited
fractures, which M. DupuxTiiETf considers as very injurious. They imagined it
was absolutely necessary to cut out both fragments of the bone before a solid
callus could be laid down; hence they avoided this operation in a great number
of cases when this resection was extremely difficult if not impossible: thus, for
example, they rarely had recourse to it in fractures of the femur, where the
frag-ments frequently ride upon one another; the upper portion is the only one
which can generally be got at with facility, while the inferior fragment, carried
backwards and inwards, is too deep-seated to be exposed by an incision in this
direction, while the presence of important vessels prevents any operation on
the inner side of the limb. M. Dupuytren is inclined to hold this opinion as al-
together wrong, and maintains that the resection of one fragment is sufficient to
obtain the consolidation of both; at least two cases in which he employed this
practice turned out successfully. — Legons Orales,
42. On the Use of the Trepan in Tooth-ache. — The means generally employed
consist in the destruction of the nervous pulp of the tooth by laceration, cau-
terization, or the application of caustic to the bottom of the carious tooth. Ex-
penence proves that it is only necessary to destroy the dental nerve to subdue
at once all sensibility in the part. The means employed by M. Fattoki, and
which experience has proved to him is the best to be relied on, consist in the
application of a small trepan on the diseased tooth, after having conveniently
fixed the head of the patient. A few turns of the instrument are sufficient to
perforate the osseous tissue of the tooth, and the extremity of the trepan imme-
diately divides the nerve which fdls up the dental canah The section made in
this way immediately relieves the pain.
The operation, according to the old method of destroying the nerve with a
sharp-pointed instrument, seldom succeeded, as the caries rarely allowed of the
easy introduction of the instrument into its cavity, and that it was also impossi-
ble to divide the nerve in many cases completely, besides causing the patient
vexy severe pain at the time. The operation by the trepan, on the other hand,
may be always relied upon, and removes every difficulty in the section of the
nerve, as it is applied immediately over the part which the nerve traverses, and
is certain of dividing it. The application of heat to the part is not a sure re-
medy, as the cauterization must be very shght — it gives out heat rapidly, and
when applied to the part has only sufficient heat to burn deeply. Some have
advised the direction of a flame of hydrogen gas on the part, but it is not ne-
cessary to dwell long on the uncertainty of such an application. In using the
trephine, there is no risk of wounding any parts of the mouth near the affected
tooth; when its application to those which are situated far back, near the ascend-
ing ramus of the lower jaw, is facilitated by the use of a speculum oris. In using
caustic to the teeth, its application cannot be confined to the seat of the injury,
Surgery. 503
and it spreads sometimes to the neighbouring healthy parts, causing and in-
creasing irritation of the dental nerve, and sometimes an inflammation of the tis-
sue of the gums. Nothing of this kind can happen in using the trepan.
This remedy may be used successfully in all affections of the teeth, from
whatever cause they may arise; and whilst many other remedial means lead
001 to the loss of the tooth, the trephine preserves it, in immediately relieving
the pain, and preventing its return.
M. Fattori has found the trephine particularly useful in that affection of the
teeth which he denominates internal caries^ where the part is extremely pain-
ful, without showing the slightest appearance of alteration in its tissue. It is in
such cases that the patient, having borne the pain for a considerable time, con-
sents to the extraction of the tooth, which in being done is frequently broken
off, and the fangs, which are often very painful, remain in the alveolar process.
When relief does not follow the application of the trephine, the pain which re-
mains is frequently the result of antecedent inflammation in the neighbouring
parts, requiring a particular treatment for its relief. It is adviseable after the
operation to fill the aperture made by the trephine with lead, to prevent any
portions of aliment or other foreign substance from lodging in it, and becoming
a fresh source of pain, by irritating the newly-incised nervous surface. This,
however, should not be done until some days after the operation, when the
parts shall have lost all their sensibility, and the irritation of the neighbouring
parts is subdued. The application of the trephine is useful when old stumps
of teeth, which cannot be removed, become painful; and finally, it is exempt
from all those accidents which attend the extraction of teeth. — Irxhiv. Gen.
43. Treatment of Fractured Limbs, hy Inclosing them in Plaster Moulds, &c. — •
The eminent German surgeon Dieffejvteach is in the habit oftreating many cases
of fracture, especially of the bones of the leg, by enveloping the limb, or only
;fths of its circumference with plaster of Paris, after it has been ascertained
that the fractured extremities lie in normal apposition with each other. It is of
advantage to leave the anterior part of the limb exposed, as we have thereby
an opportunity of watching the progress of the cure, and of applying any local
remedies which may be necessary, especially when the case is one of compound
fracture.
The principle of Dieffenbach's plan, that of an unmoveable apparatus round
the broken hmb, has been adopted by many surgeons both of ancient and of
modern times. It is to that glory of French military surgery, M. Larrey, that
we are chiefly indebted for its establishment in present practice. In the Hussian
campaign, the method was most extensively adopted, and many a limb which
had been fractured by gun-shot injuries, and had been thus treated, was found
on the return of the poor fellows to France, to have knit together most admira-
bly, although the dressings had never once been removed from the period of
the accident.
Larrey's apparatus has also the great advantage of being composed of mate-
rials the most simple, cheap, and almost always at command; for all that is re-
quired is a quantity of linen, straw, eggs, camphorated spirits, and of cold lead
lotion. The mode of its adjustment is little more complicated than the applica-
tion of a common bandage; and when once secured, the member is compa-
ratively safe, and the patient, instead of being condemned to repose for a
lengthened period, may be permitted to rise on the third or fourth day, and
move about on crutches. Whatever be the hmb which has been fractured,
there is little risk of the apparatus being disturbed, even by a long journey;
and if the jolting of the carriage be painful or improper, there is nothing to pre-
vent the simultaneous employment of suspension, as proposed by M. Sauter.
But often this is not necessary; for in from twenty-four to thirty-six hours, after
the apparatus has been applied, it forms a compact, coherent, and accurately
fitting mould or case round the whole of the limb, so that no one part of it can
be moved without the rest of the limb following the motion; thus all danger of
504 QUARTERLY PERISCOPE.
lateral displacement is securely g-iiarded against. It may be supposed that it is
less efficacious in counteracting the shortening- of the broken limb than some
methods of permanent extension; this may possibly be true, but when it is
stated that, out of eight cases of fractures of the femur, six were cured, without
any shortening of the extremity, the argument cannot form any very potent ob-
jection to the practice; and indeed the very fact of all the muscles of the limb
being equably and strongly compressed, (for the apparatus should be made to
incase the whole of its length,) subdues in a great measure their tendency to
contraction, and therefore obviates the tendency of the bones to ride over each
other.
But if the immoveable apparatus which we have so strongly praised, and
which our readers will find described at length in the 3d vol. of Baron Larrey's
Clinique Chirurgicale, and also in an admirable thesis published lately by his
son, possessed no other advantages besides the one of permitting the patient to
move about safely during the treatment of his fracture, we should deem this
sufficient to recommend it to the notice of surgeons; perhaps a case in point
will be received as the most satisfactory evidence of the benefits accruing from
its adoption.
A man of healthy constitution was admitted into a hospital for a complete
fracture of the bones of the leg, about two inches above the malleoli. During
six weeks he was treated by the common method, but at the end of that time
it was found that union had not taken place. The foot being considerably evert-
ed, M. Berard first brought it into its right position, and then retained it there
by means of Dupuytren's splints for another month and a half; and although
there had been no displacement all this time, there was still a complete failure
of any bony union. The immoveable apparatus was now applied; and when
this had become sufficiently firm and compact, the man was allowed to get out
of bed and walk about the ward on his crutches, without ever putting the
broken limb to the ground. After the expiration of six weeks a perfect cure was
obtained. — Med. Chir. Rev, from Archives Generales,
44. On Bony Union of Fractures of the Neck of the Thigh hone. By Sir Astlet
Cooper. — I find in a report of Le Baron Dupuytren's lecture, that he attributes
to me the opinion, that fractures of the neck of the thigh bone, within the cap-
sular ligament, not only " never unite, but that it is impossible they should
unite by bone." *
It is quite true that, as a general principle^ I believe that those fractures unite
by ligament, and not by bone, as do those of the patella and olecranon. But
I deny that I have ever stated the impossibility of their ossific union; on the con-
trary, I have given the reason why they occasionally may unite by bone.
The following are my words — " To deny the possibility of their union, and to
maintain that no exception to this general rule may take place, would be presump-
tuous.*'
I then proceed to state, that the cause of the deficient union is to be found
in the reflected ligament of the cervix femoris being torn through, and that
thus a defective nutrition of the head of the bone is produced. But I held, that
if the reflected ligament remained whole, or was but slightly torn when the
bone was broken, it would unite by means of its cancellated structure; but that
in such a case the limb would not be shortened in the usual manner, nor would
the case have the common characteristics of this accident.
In proof of the truth of these observations, I shall give the following quotation
from Mr. Swan's work on the Diseases of the Nerves, page 304.
*' Case. — Mrs. Powell, aged above eighty years, fell down in the afternoon
of the 14th of November, 1824. I saw her soon after, and found her complain-
ing very much of pain in the left hip. The limb could be moved in every di-
rection, but this motion produced excessive pain. She lay on her back, with
the limb extended; and nothing luas ever done, except the application of fomen-
tations for the first few days, I believed there was a fracture of the neck of
Surgery, 505
the thigh-bane, although the limb remained quite as long as the other, and I
neither perceive a crepitus, nor any altered appearance in its position, except a
shght inch nation of the toes outwards. She had more constitutional irritation than I
ever observed from a similar accident. She suffered much pain in her hip and
was in consequence obliged to take an opiate; but she got very little rest. She
generally had much thirst. There was the utmost difficulty in keeping her
bowels open; and she had great pain and difficulty in making water. She had
no appetite for common food, and for three weeks appeared so weak, that she
was under the necessity of taking wine and brandy. For some time all her urine
and stools were passed in bed, but not involuntarily, and only because she could
not be persuaded to use proper means; in consequence, her back became very
sore. Latterly she complained of pain in the abdomen, which was very tender
on pressure, and made even the weight of the bed-clothes inconvenient. Her
tongue became very dry and brown; and in the last twenty-four hours she was
insensible. She died on the morning of the 19th of December, about five.
" Examination. — This took place at seven in the evening.
*' There was some ecchymosis amongst the muscles about the injured part,
and in the cellular membrane, about the sciatic and anterior crural nerves. The
greatest part of the fracture of the neck of the thigh-bone, which was entirely
within the capsular ligament, was firmly united.
*' A section was made through the fractured part, and a faint white line was
perceived in one portion of the union, but the rest appeared to be entirely bone."
Mr. Swan goes on to say, *' This beautifully shows the principle which Sir
Astley Cooper has advocated — viz. that when the reflected ligament remains
whole, and the bones are not drawn asunder, the nourishment to the head of
the bone continues, and union will be produced even in the short space of five
weeks, by only placing the knee over a pillow, and in other respects leaving
the case to nature."
Of the contrary state of the fracture — viz. that in which the reflected liga-
ment is torn — I may give the case sent to me by Mr. Robertson, of Sheerness,
in which the patient's limb was extended for six months without any ossific
union.
On the 25th of June, 1822, William Durain, aged 62, a tall, athletic convict,
of a sanguine temperament, fell, with a very inconsiderable violence, across a
piece of timber in the Dock-yard, his left hip coming in contact with the wood.
On rising, he felt an acute pain in the region of the acetabulum, but no other
inconvenience, for he walked on board to exhibit himself to the surgery-man.
From finding him ranked up with the sick of the hulk, on my morning visit of
the 26th, from his walking on board, and from his own account of the accident,
I did not suspect any serious injury to the joint, and treated the case as one of
concussion. On the 29tli, however, he complained of a very sudden and very
agonizing accession of pain, which induced me to subject him to a more critical
examination. No evident alteration in the size of either hip could be discern-
ed, but a shortening of the limb was conspicuous, which was rendered more
evident by making him stand upon the sound limb: extension removed this dif-
ference; but, on being freed from restraint, it again assumed its morbid shape;
the knee and foot were everted, and rotation greatly increased his pain.
T removed him to the hospital, as a case of fracture within the capsule; but
a continued attention for a period of six months to position, (chiefly with a view
of restraining the motion of the pelvis, and of securing the limb,) made no other
alteration in the symptoms than a gradual diminution of pain: a pair of crutches
were given him, he was placed on the invalid list, and remained till the 26th of
September, when he died from general dropsy. On dissection, tli<e injury
proved a transverse fracture of the head of the femur, within the capsular liga-
ment; no species of union had taken place. The upper portion of the fractured
bone was retained in situ, by the sound ligament, tolerably smooth upon its sur-
face, but without any ossific deposit.
The lower portion was very irregular, with several detached pieces of bone
No. XXVllI.— August, 1834. 43
506 QUARTERLY PERISCOPE.
adhering' to the Insertion of the capsular lig-ament. Between the acetabulum
and the portion of bone retained in situ by the lig-ament, were several small
oval-shaped, loose cartilag-inous substances, apparently fragments of bone; the
capsular ligament partially lacerated, in a line above the trochanter major, and
g-reatly thickened in its inserti*ons.
I should not have p^iven you this trouble, nor should I have taken it myself,
but for the respect I bear my friend the Baron Dupuytren? for, although 1 have
already submitted myself to be misrepresented by many individuals, yet 1 should
be sorry to be misunderstood by so excellent a surg-eon, and so valuable a friend,
as le Baron Dupuytren. — Medical Gazette, Jipril 25thy 1834.
45. Amputation with a Single Flap. — Dr. Legkos recommends for amputa-
tions of the thig-h and arm the following method, which he conceives to unite
the advantag-es of the flap and circular operations witliout having- the inconve-
niences of either. The patient and assistants being" conveniently arrang-ed, the
surgeon grasps with one hand the muscles on the anterior face of the thigh,
draws them from the bone; with the other hand he thrusts a knife held flat
entirely through so as to separate these muscles from the bone, and forms
a semilunar flap of six or seven inches. The operator carries back his knife to
the bottom of the flap, which is raised by an assistant, divides the flesh which
remains posteriorly, as in the circular method, and saws the bone, rounding if
he thinks necessary its upper and lower edge.
Instead of commencing the flap b^^ a puncture, and cutting from within out-
wards, the operation can be performed by an incision from without inwards,
that is, from the skin to the bone.
The single flap may be cut square: if these measures are well teiken nothing
is easier than to make the lips of the wound meet perfectly.
This plan, as may readily be conceived, may be applied to the arm, however
we prefer for this limb the circular method. Without regarding the facility and
quickness with which this new plan may be practised, it appears to us to pre-
sent the following advantages.
The flap unites by its own weight and facilitates by its position union by first
intention, which by this manner can be very soon obtained.
The bone ()laced in the middle under a very considerable portion of flesh,
does not tend, as in other methods, to project at the angles of the wound.
The angle being at the lowest point, the fluids flow out of their own ac-
cord, and by the most direct passage.
In case of haemorrhage it is sufficient to raise the flap to discover the vessel
from which the blood proceeds, and to twist or to tie it. The principal artery
is found at the internal angle, and on a level with the wound.
By this method we avoid the conical form of the stump, the projection and
exfoliation of the bone, the dragging caused by th^i dressings, and the search
for the vessels which bleed primarily or secondarily.
The contraction of the stump, separation and gangrene of the skin, are not to
be feared, and of phlebitis there is little chance whether originating from in-
flammation of the veins or the absorption of pus— -the surface of the wound be-
ing protected from external causes.
The cicatrix in this method is linear, is not in the centre of the limb, it is be-
yond the reacli of external injuries. This position, together with the muscular
mass which forms and terminates the stump, facilitates the application of an ar-
tificial limb. — Journal des Connaissances Med. Chirurg. February, 1834.
46. Case of Osteosarcoma of the Left Upper Maxillary Bone, in which the
whole of the Diseased Bone was Removed. By M. Blandij.-. [Reported by M.
Laplace.] — The subject of this operation was a female, fifty-five years of age,
habitually healthy, and the mother of several children, who enjoy good health;
she affirms that she never contracted syphihs, and traces the commencement
of her disease to six months back. At this period one of the left upper molar
Surgery. 507
teeth became spontaneously the seat of excessive pain, loosened, and in a short
time fell out, leaving an opening* which never closed since. At the same time
two small fleshy tumours, as large as a pea, red, and smooth, developed them-
selves on either side of the fistula, which gave issue to a small quantity of puri-
form mucus, fetid, and sometimes mixed with blood. A surgeon being now-
called upon, made some trifling incision, which gave issue to some blood, and
from that day the tumours gradually enlarged.
On being received into the hospital, 11th of March last, she presented the
following appearance: — At the roof of the mouth there was a red, smooth, fun-
gous tumour, but it was not ulcerated, and did not bleed? this tumour com-
prehended the whole breadth of the left upper maxillary bone, and occupied
from before backwards the alveolar ridge and vavdt of the palate as far as the
insertion of the velum palati. The whole alveolar ridge had disappeared, and
was confounded with the body of the tumour, which was as large as the half of
a hen's e^g?:;. Corresponding with the presumed situation of the second or third
molar tooth there was an opening, furnishing a sanious, fetid pus, through
which a probe might be passed deeply into the antrum. The left cheek was
elevated by the tumour, which seemed to mount up to the base of the orbit in
front, and to the side of the nose laterally. The globe of the eye on this side
was not displaced; the patient experiences great intermitting pain in the tu-
mour, and has been affected with head-ache, though not laterally; she coughs
a little, and expectorates mucus mixed with pus from the alveolar" fistula; the
general health was not altered.
During the following days the little finger could be introduced into the
maxillary sinus through the fistula, and feel some irregular, but smooth fungosi-
ties in the interior of that cavity, not a single point of its parietes presented the
osseous resistance characteristic of a healthy state; the examination was fol-
lowed by a discharge of blood; the progress of the tumour latterly had been
very rapid; it had exceeded the median line to the right, and gained the inner
edge of the right superior maxillary bone.
MM. Marjolin and Blandin, seeing the quick manner in which the osteo-
sarcoma advanced, were of opinion that complete removal of the whole supe-
rior maxillary bone was necessary, and on the 18th of March, M. Blandin, in
the presence of several surgeons, proceeded to the operation.
The patient was retained in a chair by tv/o assistants, and the operator placed
himself before her, having on his left all the necessary instruments arranged in
perfect order, and under the care of another assistant. The left half of the
upper lip was put in a state of tension between the left hand of the operator
and an assistant, and an incision was made, commencing over the os malss, be-
low and outside the external angle of the eye, and dividing the upper lip two
or three lines in front of tlie left commissure. The coronary branches were
now tied, and the tlireads cut close to the knots. The external flap, sufficiently
dissected back to expose the anterior edge of the masseter muscle, was com-
mitted to an assistant; the internal flap was also dissected from below up, and
from without inwards, the wing of the nose was separated from the maxillary
bone, and turned up; the corresponding nasal fossa opened in front, outside
and below; the perpendicular process oT the superior maxillary bone, and the
base of the orbit, were exposed. The globe of the eye, with its cellular tissue,
separated from the floor and inferior angles of the orbit, was pushed up by a
spatula.
During this first period of the operation, the soft parts alone were interested;
it now remained to separate the hard parts. The globe of the eye was care-
fully elevated inwards, together with the internal flap, while the external one
was depressed in the opposite direction; a small hand-saw was now placed on
the middle of the articulation of the superior maxillary with the malar bone;
the flat of the blade being parallel to the median line, and directed from before
backwards, regarded the anterior extremity of the inferior orbital fissure
in such a manner, that the anterior angle of the os malje was on the inner
508 QUARTERLY PERISCOPE.
side, and the malar process of the superior maxillary bone on the outer side
of the cut.
The anterior moiety of the osseous mass placed in front of the inferior orbital
fissure being- thus divided, the separation was continued as far as the latter fis-
sure, with the gouge. As the instruments were now to be dh'ected against the
inferior and inner edge of the orbit, the globe of the eye was, raised outwards,
and the internal flap turned to the right side. The saw being fixed on the ex-
ternal face of the ascending process of the superior maxillary bone, divided
it obHquely from above, downwards, and from without inwards, in an obhque
direction, passing through the superior external and inferior internal angles of
the orbit, and directed from before backwards toward the posterior third of the
spheno-maxillary fissure. The ascending process having been thus divided by
the saw, the separation of the bone as far as the spheno-maxillary fissure was
completed with the g-ouge, following- precisely the ethmoido -maxillary fissure
of the orbit.
The osseous portion which was to be amputated being thus separated supe-
riorly both on the outer and inner sides, still remained attached behind the tu-
berosity of the maxillary bone, at the vault of the palate and the wall of the
nasal fossae. The internal flap being raised sufficiently, together with the upper
lip, the left index finger was introduced deep into the mouth, which was kept
open by means of a cork; the finger served to protect the velum palati, and to
direct a long strong pair of scissors, which were introduced from before back-
wards through the nasal fossx, each fossa receiving a blade; the septum was
thus divided parallel to its base, where the vomer is very thin.
The necessary number of teeth Avere now extracted, and the bistoury traced
on the gum and roof of the palate the line which the saw was to follow. This
instrument divided the superior alveolar edge parallel to the median line, and
from before backwards. The section was completed with the gouge, by which
the osseous portion of the roof of the palate was divided in its whole length.
The left moiety of the velum palati was now separated from the rest by means
of a transverse incision, which, passing along the posterior edge of the horizon-
tal portion of the palatine bone, was directed between the pterygoid process
and the maxillary tuberosity. The soft parts being thus divided, the gouge
was employed to separate the superior maxillary and palatine bones from the
sphenoid, acting obliquely from above downwards, and from without inwards.
The tumour was now completely isolated, it could be seized between the fin-
gers, and when all the soft parts were cut through, its removal was terminated.
The result of this operation, in which the internal pterygoid muscle was
completely exposed, was the formation of a vast cavity where the left orbit,
nasal fossee, the pharynx, and mouth, all communicated. The parts were now
cleaned with a sponge, and some fragments of the orbit and palatine bone,
with some fungous excrescences, were removed; the edges of the wound were
now brought together with eight strong pins, on which the twisted suture was
placed; the cheek did not present any sensible depression.
The consequences of this difficult and long operation did not present any
thing- remarkable, the termination being most fortunate; there was very little
reaction, whether general or local; neither haemorrhage nor nervous symptoms
supervened. During the first few days the patient expectorated some mucus,
at the beginning mixed witli blood, but soon becoming yellow. On the 21st
we observed over the upper eyelid and left cheek a little redness and oedema,
but these were quickly dissipated. The patient, whom we could not compre-
hend at all at first, was soon able to make herself well understood, though the
voice was nasal. Finally, she was able to leave the hospital in the beginning-
of May, when she presented the following appearances: —
On the cheek a simple cicatrix. In the cavity of the mouth, a sort of perfo-
ration of the velum palati, establishing a communication between the mouth
and nasal fossae, permits us to see the septum and turbinated bones. This arti-
ficial perforation is limited in front by the cheek; behind by the left moiety of
Midwifery. 509
the velum palati; its edges are completely cicatrized. The left cheek is a little
fallen in, and the left wing of the nose, being drawn closer to the septum than
natural, diminishes a little the nostril of that side.
The examination of the tumour which was removed, perfectly confirmed
the diagnosis; it was composed of true osteo-sarcomatous tissue, by which the
;jreater part of the bone had been destroyed.
This case of complete removal of the whole of the superior maxillary bone,
joined to a few other authentic ones which are recorded within the last years,
proves that this operation, though in appearance dangerous and frightful, must
take its rank amongst the other great efforts of the art to remove a disease
otherwise inevitably mortal. — Lancet^ May olsY, 1834.
MIDWIFERY.
47. Destruction of the Neck of the Uterus^ with complete absence of the Os Uteri.
Vaginal Csesarian Operation. — Complete obliteration of the os uteri at the mo-
ment of labour is very rarely witnessed by accoucheurs. We find, indeed, in
writers, many examples of the kind; but in most of these cases the observer
has been led into error by a vicious or elevated position of the neck, which
sometimes exists to such an extent, that, without very careful examination, an
absence of the uterine orifice might be declared. In the present case, however,
the fact of obliteration was established by several celebrated midwifery practi-
tioners, and existed to a degree requiring the vaginal operation, which was per-
formed with com.plete success.
Case. — On the 4ih of December, 1833, Dr. CafFe was called upon by Madame
Mauray, sage-femme, to see a lady who had arrived at her establishment the
night before, and was at the full period of gestation. This lady, thirty-nine
years of age, and of a good constitution, was the mother of three children, all
born by easy labours. Her last accouchement took place eight years ago, and
gave rise to no accident whatever. The labour-pains had been present for
thirty-six hours, without having produced any serous discharge; and the mid-
wife was unable to discover the presence of the os uteri, or even the entrance
of the organ.
On making an examination, M. CaflTe recognised the following particulars: —
The vulvo-uterine diameter of the vagina measured five inches; its superior
wall, excessively tumefied, formed a kind of hood which filled a part of the va-
ginal cavity; the latter was red, and not moistened by mucus; the apex of the
vagina terminated suddenly, and might be compared to a cylinder closed above,
without any trace of projecting body or uterine neck. Near the median raphe
of the posterior wall, the finger touched a fold, about a line broad, giving the
sensation of a small cord drawn tensely; but at the sides of this fold, or else-
where, it was impossible to find the least trace of os uteri, either with the
finger, or by guiding a probe-pointed stylet on the latter. During the violent
expulsive efforts which took place from time to time, the pulp of the fin,q:er ex-
perienced the sense of motion communicated to it; but the uterus at the same
time remained elevated, without projecting into the vagina.
MM. Ilatin, Velpeau, Lenoir, and Larchet, were now called upon to examine
the case, and all recognised a complete obliteration of the uterine orifice; an
operation was therefore determined upon, and performed in the following
manner.
The woman being placed on the edge of her bed, as in the operation for the
stone, M. Gaffe introduced, on the left index finger, a straight narrow-bladed
bistoury, protected by a roll of linen within six lines of its point, and guarded
by a ball of wax. Having arrived at the summit of the vagina, the direction of
the bistoury was changed from the flat to the perpendicular position, its back
being supported by the pulp of the index; and the anterior wall of the uterus
43*
510 QUARTERLY PERISCOPE.
was divided, layer by layer, the incisions being" made from the rectum towards
the bladder, and care being- taken not to extend them beyond five lines up-
wards. When the incisions had been carried to about one-quarter of an inch
in depth, the operator arrived at the cavity of the uterus? a very dark, inodo-
rous liquid, about four ounces in quantity, was immediately discharged.
The uterine contractions aided much the divisions made by the bistoury, and
in order to avoid any danger of laceration, two lateral incisions were made with
a probe-pointed bistoury, one on the right and tlie other to the left, extending-
a few lines only; at this moment a contraction of the uterus enlarged the cru-
cial incision thus made and rendered it oval. After the lapse of an hour the
labour was terminated, most fortunately, and without any laceration whatever.
No foreign substance of any kind was introduced into the wound: the female
was able to leave her bed on the sixth day, and on the ninth returned home.
After the cessation of the lochia, M. Caffe took the precaution of introducing
on several occasions, into the wound, a g'um-elaslic catheter, which was there
retained for a few hours each time, in order to prevent its closure. This pre-
caution was attended with the desired effect, for since the performance of the
operation, the menses have appeared twice, and been discharged without any
obstacle. The cause of the obliteration in this case arose from the introduction
of an irritating matter into the organ. M. Caffe was informed by the patient,
that during the early months of her pregnancy, she had frequently injected,
with a gum-elastic tube, a solution of ashes into the vagina, and even into the
uterus. Each time this manoeuvre was performed, the woman was seized with
intolerable pain, and the injections gave rise to a discharge of pus from the va-
gina, mixed with some pellicles. The woman did not complain of any pain
during the operation, which was extrem,ely simple, and followed by no accident
or inflammatory symptoms; and the division of the uterine parletes did not give
rise to the slightest hsemorrhage. — Journal Hebdom. Marchy 1834.
43. Case of Accumulation of Air in the Uterus simulating Pregnancy. By J.
JoifES of Gelly, Montgomeryshire. — On the 3d or 4th of April, 1 was applied to
by a widow, accompanied by her daughter, an unmarried female, nineteen
years of age, under the following circumstances: — The mother stated that her
daughter's health had been gradually declining for some months past, that she
was suspected to be pregnant, and that she, (the mother,) wished me to decide
whether she was so or not. The girl, who was of a naturally robust constitu-
tion, presented the appearances of impaired health. She was considerably
emaciated; her countenance was sallow; tongue furred and white; pulse 84, and
extrem.ely small. She said that slie had frequent vomitings in the morning,
anorexia, and constipated bowels. She attributed the commencement of her
illness to her having been suddenly exposed to cold and wet during menstrua-
tion six months previous; the catamenia were suppressed, and had not since ap-
peared. About three months after this period she first perceived her abdomen
to be preternaturall}'- enlarged, and this enlargement had progressively in-
creased up to the time of her application to me. It was then of the ordinary
size of that of a female in the seventh, or the latter part of the sixth month of
pregnancy, and the uterus was distinctly felt to reach as high as the umbilicus.
I applied the stethoscope to various parts of the abdomen, but no sound was
discernible, having the slightest similarity to that of the placental or foetal pul-
sations. The mammae were flaccid, and the areolae surrounding the nipples
wanted that deep red colour which is so characteristic of pregnancy. A vagi-
nal examination was positively refused; and under all the circumstances of the
case, I felt incompetent to form any decisive conclusion, whether the girl was
pregnant, or laboured under some uterine disease.
After the lapse of three days I was again visited by this young woman, when,
to my astonishment, I found the abdomen was reduced to its natural dimen-
sions; the uterus was no longer to be felt above the pubis, and her health, she
said, was much improved, her general appearance, indeed, very clearly proving
Midwifery, 511
this to be the case. The account she gave was, that on g-oing to bed the first
night after she had appUed to me, she suddenly, to use her own expression,
felt something burst in her inside, and instantly a profuse quantity of extremely
fetid gas issued joe?- vaginam^ mixed, however, with a few small clots of blood.
The flatus, she said,' must have continued to discharge for at least two minutes,
when she felt faint, and subsequently became quite insensible. The mother
corroborated the testimony of her daughter, and stated such to have been the
foetor of the gas expelled, that she found it impossible to remain in the same
apartment with her daughter.
I much doubted the truth of this narration, and suspecting that abortion had
taken place, I determined to prevail on the girl, if possible, to allow me to
make a vaginal examination, and after a great deal of persuasion, succeeded,
when I instantly found that the vagina was entirely closed by the hymen, vrith
the exception of a small orifice, certainly not half an inch in circumference,
through which the catamenia had escaped, — a strong proof that the girl had
never indulged in illicit intercourse with the other sex, and coupled with the
other circumstances of the case, that the testimony of her and her mother was
faithfully true. The girl, after this occurrence, rapidly regained her former
health. The catamenia have once since appeared, and she is now, in everj*"
respect, perfectly well.— Lotrtce/, May Sls^, 1834.
49. On iJie Impediments to Easy Delivery^ from some Malformations of the
Fodius. — It has been too generally admitted, that those monstrosities only which
are characterized by an excess or redundancy of parts, or by extreme malposi-
tion of these, can afford any real impediment to the expulsion of the child. A
few examples will prove that this affirmation is not quite correct? but it will be
proper, before particularizing them, to make an illustrative remark or two.
1. If the limbs of the foetus be so wasted away, or so imperfectly formed, that
they look rather like stumps, or like turtle-flappers, than like the ordinary
lengthened extremities, the foetus is necessarily more moveable in the liquor
amnii, and must, in consequence of this, be more liable to a mal-presentation.
If, in such a case as this we have supposed, we should wish to deliver the
child by turning, our diagnosis of the parts which we fell may very probably be
obscure and perplexing — add to which, there may be no convenient part to lay
hold of. It was in an example of this kind, that Pen was obliged to apply the
crotchet upon the sacrum, and Delamotte confesses that he was once exceed-
ingly puzzled to distinguish the different parts of a monstrous foetus.
2. In anencephalous monsters, whose spine is found open behind, the head
is usually thrown backwards, and the occiput is actually concreted with the cer-
vical vertebrae. Such a malformation must seriously impede delivery, (if the
foetus be moderately large,) as the whole body is thereby an unpliant mass.
Fortunately, these monsters are seldom carried the full time; but, even at the
eighth month, they very commonly cause a tedious and painful accouchement.
It is frequently necessary to effect the delivery by turning.
There are many other deformities of the foetus, which may be unfavourable to
the naturally easy expulsion of the child; such are adherences of the limbs to
each other, or to the body, or of the foetus to the secundines, (an anomaly which
is frequently associated with some malformations of the fcKtus itself, as eventra-
tions, &c. and which Geoffrey St. Hilaire considers to be, indeed, the cause of
the malformations,) or, lastly, an abnormal agglutination, or torsion of the na-
vel-string. The mere death of the foetus has been very generally supposed to
render a labour less easy; and indeed the ancients believed that the expulsion
was effected chiefly by the efforts of the child itself. To a certain extent, we
must confess, this idea is correct; for there can be little question but that the
death of the foetus, by disturbing or arresting the utero-placental circulation,
must have the effect of impairing the contractility of the womb, and should pu-
trefaction have commenced, so as to render the flesh soft, loose, and inelastic,
the foetus must act almost as a plug, filling up the passage, and merely, per-
512 QUARTERLY PERISCOPE.
haps, protruded by the violent contractions of the expelling- org-an, without any
power of accommodating- itself to the different turnings. When the body is in
this soft state, it does not well transmit the impulsion communicated by the ute-
rus to the head, but often rather bends or folds upon itself, and thus presents
an unfavourable part to the os uteri — a part which is very rarely protruded first
in a living- child. The analysis of obstetrical tables will be found to corroborate
this statement. Out of 15,652 births, at the Hospice de la Maternite, 689 chil-
dren were still-born — of these 689, 539 were in a putrid state, or in the pro-
portion of 7 to 9. The following: exhibits the mode of delivery in these cases: —
f by the vertex -^ .j^
Born spontaneously ^ »'P^ * -^ „
V_ shoulder 4
Delivered with the forceps - - - 5 Y^^^h^ d 1
Delivered by turning ^ ^l'^^ ^
Delivered after craniotomy 2
539
According- to this table, it appears that, in one case out of every eighteen in
which the foetus was putrid, recourse hud to be made to the use of the hand, or
of instruments, to effect the delivery; whei-eas, in the labours of living children,
the proportion is a great deal lower — once in i\bout 60 cases.
To illustrate the remarks on the occasional impediments to natural accouche-
ment, from some malformations of the foetus, we shall adduce an example or
two.
Obs. 1. Anencephahus Fostus, born easily and naturally. — A woman, 31 years
of age, was admitted into the Maternity to be delivered of her fourth child.
During her pregnancy, she had suffered much from cardialgia and anorexia;
when admitted, the membranes had alretidy broken and the waters freely dis-
charged, but the labour-pains did not come on for a few hours afterwards. When
the OS uteri had dilated sufficiently, the presenting part of tlie foetus could not
be satisfactorily made out — it felt quite soft, and was at first supposed to be the
genital organs, but the hips could not be traced; and, by continuing the exa-
mination, one of the arms was felt.
As the labour proceeded, the soft mass was protruded lower down, and in
the middle of it, the accoucheur thought that he could feel a sort of opening,
which received the extremity of the finger. The expulsion was gradually ef-
fected. On examination after delivery, it was discovered that the tumour was
a large reddish fungosity which cover<:^d the entire base of the cranium, and
occupied the place of the brain. The foetus was malformed in other respects,
for the anus was imperforated, and there v^-ere no traces of external genital or-
g'ans; there were also only four toes on each foot.
Obs. 2. Anencephalous Foelus, presenting the Shoulde) — Delivery hy Turning. —
A middle-aged woman, pregnant of her second child, was seized with labour-
pains in the eighth month. The pains had been preceded by haemorrtiage, and
when the state of the parts was ascertained by " le toucher," it was found that
the placenta adhered to the os uteri: higher up a hand could be felt, and, by
following this, the forearm and arm might be traced; the foetus was still
alive, but very small — the delivery was effected by turning. The foetus was
monstrous, for the cranium was altogether destitute of its vault, and, in the place
of the brain, nothing was to be seen but vesicular fungosities, full of serosity.
It lived for a moment or two after its expulsion, but never breathed.
General Re marhs. — It is important to observe that, independently of the more
frequent malposition of a dead, than of a living foetus, we have oftener the ne-
cessity of employing instruments in the one case than in the other; the fore-
Medical Statistics. 513
going table shows that this happens about once in 38 dead labours, even when
the presentation is quite normal. If the data of other institutions agree with
those furnished from the Maternite, the conclusion of the ancients, previously
alluded to cannot be gainsayed^ and, at all events, we must admit that a liv-
ing foetus is more favourable for easy expulsion than a dead one. But, in truth,
the idea, although ridiculed by Petit, and by most subsequent accoucheurs, is
not a whit more improbable than a favourite one of late years, we mean that
which attributes the ordinary presentation of the head to an instinctive, and, in
some degree, a voluntary effort or culbute of the foetal being to direct its head
foremost.
M. Paul Dubois read a very ingenious paper on this subject to the Royal Aca-
demy, (of which an abstract is given in a late No. under the head of the Pro-
ceedings of the Institute,) but his reasonings are often fallacious, and many of
the data on which they are founded are not correct. The great frequency of
malpresentations in cases of deformed foetuses cannot surely be attributed to
the feebleness of the instinctive and spontaneous effort of the foetuses, but de-
pends much more probably on their excessive mobility in the liquor of the am-
nion, monsters being very generally smaller, and occupying less space than
healthy children. Whenever the fatus floats about freely in the uterus at the
time of labour, the chances of malpresentation are much increased; and as it is
only in the latter months of natural pregnancy that the foetus occupies nearly
the whole of the cavity of the uterus, and as the head is at this period heavier,
although by a very small excess of preponderance, than the rest of the body,
the reason of the most common, and therefore the natural presentation is suffi-
ciently obvious. We do not however mean to deny in toto, the occurrence of
any instinctive movements of the foetus in utero, for we believe that they do
take place, and moreover that their frequency is in proportion to the inconve-
nience and constraint of the position in which the foetus chances to be placed,
but these movements must be blind, and obedient much more to the operation
of mere gravity than to the choice or the will of the young being. Within this
limit we consider its instinct to be comprehended, that it endeavours to resist
any painful or disadvantageous position, say, for example, the presentation
of the face, (a presentation which is much more frequent when the child is
dead, than when it is alive; the proportion being as 5 to 97;) and simply because
certain muscles are thereby forcibly and distressingly extended; in consequence
of this the living being struggles against it.
But surely this admission does not warrant us in saying that the foetus instinc-
tively chooses the position most favourable to its birth; with as much propriety
we may suppose that it voluntarily turns round tlie occiput, so as to bring it
under the symphysis pubis, during the second act of parturition; all that we
can fairly infer is that it strives against any position or attitude which is painful
or irksome. The ingenious doctrine of M. Dubois would therefore be more
correct if it simply enounced *' that the child contributes by its automatic move-
ments, to the gliding of the head towards the most depending part, which is the
cervix of the womb." — Med. Chirurg. Rev. from Rev. Med,
MEDICAL STATISTICS.
50. Statistic Views of the Mortality in Various Countries in Europe. — An article
under this head in the Edinburgh New Philosophical Journal, for April 1 834, con-
ducted by Professor Jameson, exhibits an interesting view of the proportional mor-
tahty in the principal European states, the difference in which is very considera-
ble. The computations profess to be founded upon official documents obtained
in late years, and the following comprises a summary of the most interesting re-
sults, which will constitute a valuable addition to the stock of medical statistics
wuth which the pages of the American Journal has been enriched.
The proportion of deaths to the population in the Roman territory and the
514 QUARTERLY PERISCOPE.
ancient Venitian provinces, is 1 inhabitant in 28; in Italy g"enerally, Greece, and
Turkey, 1 in 30; in the Netherlands, France and Prussia, 1 in 39; in Switzerland,
the Austrian empire, Portugal and Spain, 1 in 40; in European Russia and
Poland, 1 in 44; in Germany, Denmark and Sweden, 1 in 45; in Norway, 1 in
48; in Iceland, 1 in 53:^ in England, 1 in 58; in Scotland and Ireland, 1 in 59.
It hence appears that the shortest duration of life does not correspond with
the greatest rigour of climate. Norway, Scotland and Iceland, being much
more favourable to the prolongation of life than the milder regions of southern
Europe, where three deaths take place in the latter, scarcely two occur in the
limits of ancient Scandinavia.
" Russia and Poland, where nature and fortune have not been lavish of the
necessaries of life, enjoy however, an astonishing longevity. The population,
comprising a mass of nearly sixty millions, spin out their existence almost one-half
longer than that which is enjoyed by the inhabitants of Italy, and exactly twice
the length of time which any one can expect to live in the capital of Austria."
"The smallest mortality in Europe occurs in maritime countries, which are
in the vicinity of the polar circle, such as Sweden, Norway and Iceland. This
is also the case in countries where, as in Russia, the influence of climate is not
aided by civilization, and of itself is sufficient to assume long life to mankind."
" Countries where the heat is moderate, are not as might be supposed, among
those which possess the advantage of a small mortality; to obtain it, they must
require the benefits of a high state of social order."
*' The southern countries, the mild climate of which seems to be so favourable
to the human race, are, on the contrary, regions where life is exposed to the
greatest dangers. In the smiling plains of Italy, the chances of dying are one-
half greater than those of cold and foggy Scotland; and under the beautiful
skies of Greece, the certainty of life is one-half less than among the ices of
Iceland."
Estimates of the mortality in tropical regions made by Humboldt and others,
shows the general pernicious influence exercised by the climate of the torrid
zone, the extent of which is however different with the different races of in-
habitants; thus for example in 1805, the deaths at Batavia were 1 in 11 of the
Europeans; 1 in 13 Slaves; 1 in 29 Chinese; 1 in 46 Javanese. In Bombay in
1815, Europeans, 1 in 18;^; Mussulmen, 1 in 17^; Parsees, 1 in 24; Guadaloupe,
1816 to 1824, whites, 1 in 23^; Freedmen, 1 in 35; Martinique, 1815, whites, 1
in 24; Freedmen, 1 in 33; Grenada, 1811, slaves, 1 in 22; St. Lucia in 1802,
slaves, 1 in 20.
One of the most interesting statistic views of the mortality in various coun-
tries, is that in which the influence of the progress of civilization is exhibited,
by comparing the deaths to the population of the same country at intervals suf-
ficiently long to admit of a decided social amelioration. The following exhibits
this subject in a very striking manner.
The number of deaths compared with that of the population, was —
in 1821 to 1825, 1 in 45
in 1819 - - 1 in 45
in 1825 - - 1 in 45
in 1821 to 1826, 1 in 39
in 1825 - - 1 in 45
in 1828 to 1830, 1 in 43
in 1824 - - 1 in 40
in 1821 - - 1 in 58
in 1800 to 1804, 1 in 47
in 1825 to 1827, 1 in 39^
in 1824 - - lin47
in 1827 to 1828, 1 in 31
in 1829 - - 1 in 28
in 1821 - - 1 in 59
rrom all which it appears that the mortality has diminished.
Sweden - - -
1754 to 1763,
1 in 34;
Denmark - - -
1751 to 1756,
lin32;
Germany - - -
1788 - -
1 in 32;
Prussia - - - .
1717 - -
1 in 30;
Wurtemberg - -
1749 to 1754,
, 1 in 32;
Austria - - - -
1822 - -
1 in 40;
Holland - - -
1800 - -
1 in 26;
England - - -
1690 - .
1 in 33;
Great Britain - -
1785 to 1789,
, lin43;
France - - -
1776 - -
1 in 25J:
Canton of Vaud -
1756 to 1766,
1 in 35;
Lombardy - - •
1759 to 1774,
1 in 27^:
Roman States
1767 - -
1 in 24;
Scotland - - -
1801 - -
1 in 44;
Medical Statistics. 515
In Sweden, nearly |d in 61 years; in Denmnrk, 2-5tbs in 66 years; in Ger-
many, 2-5ths in 37 years; in Prussia, l-3d in 106 years; in Wurtemberg-, 2-5th3
in 73 years; in Austria, l-13tli in 7 years; in Holland, ^ in 24 years; in England,
4-5ths in 131 years; in Great Britain, l-llths in 16 years, in France, ^ in 50 years,
in Canton ofVaud, |d in 64 years; in Lombardy, l-7lh in 56 years; Roman
States, jd in 62 years.
The principal towns in Europe present the same gradual diminution, as will
be evident from the following proportions estimated for different epochs, viz.
Paris in 1650, 1 in 25 inhabitants; in 1829, 1 in 32
London 1690, 1 in 24 do. in 1828, 1 in 55
Berlin 1765, 1 in 28 do. in 1827, 1 in 34
Geneva 1560, 1 in 18 do. in 1821, 1 in 43
Vienna 1750, 1 in 20 do. in 1829, 1 in 25
Rome ... in 1762 to 1771, 1 in 21 do. in 1828, 1 in 31
Amsterdam - 1761 to 1770, 1 in 25 do. in 1828, 1 in 29
Cambridge .... in 1811, 1 in 41 do. in 1821, 1 in 58
Norfolk 1811, 1 in 50 do. in 1821, 1 in 59
Manchester .... 1757, 1 in 25 do. in 1821, 1 in 58
Birmingham. - - . 1811, 1 in 30^ do. in 1S21, 1 in 43
Liverpool .... 1773, 1 in 27 do. in 1821, 1 in 41
Portsmouth .... 1800, 1 in 28 do. in 1811, 1 in 38
Petersbu.-g ... - 1768, 1 in 28 do. in 1828, 1 in 48
Stockholni . in 1758 to 1763, 1 in 19 do. in 1827, 1 in 26
The causes enumerated, as tending to an increase of mortality, are chiefly — ■
The marslty humidity of the air, especially in hot countries; the effects of
privations on the lower classes of society; the scarcity of the means of subsist-
ence, or, at least, their rise in price as compared with the wages of labour; pes-
tilential diseases; unfavourable seasons, especially abrupt changes in the tem-
perature; the closeness, dirtiness, and unheallhiness of private houses, prisons,
infirmaries, and hospitals; the excessive use of spirituous liquors, and indul-
gence in drunkenness; unwholesome or unremitting labour, especially in child-
hood and youth; lastly, war, hut less in consequence nf battles than forced marches,
and frequently the mal-administration of armies.
The chiei" causes which in connexion with the progress of civilization have
tended to diminish mortality, are — the draining of marshes, and the embanking
of streams and rivers; the favourable division of public wealth, which affords to
each individual labour and subsistence; the abundance and good quality of the
food of the people; the attention bestowed on children from birth, and con-
tinued in schools, manufactories, and public establishments; vaccination and
sanitary arrangements, which prevent the importation or development of con-
tagious diseases; the low price of the productions of industry, allowing the less
affluent classes to enjoy those habits of cleanliness which were equally unknown
and beyond their reach, and furnishing them with the means of escaping the
intemperateness of the season; lastly, the successful measures adopted fordimi.
nishing the insalubrity of towns, and especially colleges, theatres, hospitals,
prisons, churches, ancl other jjublic establishments, which, in many places, are
still without the means of ventilation, heating and cleaning.
The editor concludes his interesting observations upon the restdts of the
social ameliorations which have been gradually introduced into European
countries during the last century by the following striking conclusions. *' If we
collect England, Germany, and France in one group, we find, that the average
term of mortality which, in that great and populous region, was formerly 1 in
30 people annually, is not at present, more than 1 in 38. This difference re.
duces the number of deaths throughout these countries from 1,900,000, to less
than 1,200,000 persons; and 700,000 lives, or 1 in 83 annually, owe their pre.
servation to the social ameliorations effected in the three countries of Western
Europe, whose efforts to obtain this object have been attended with the greatest
Buccess."
516 QUARTERLY PERISCOPE.
'* The life of man is thus not only embellished in its course by the advance-
ment of civilization, but is even extended by it, and rendered less doubtful.
The effects of the amelioration of the social condition are to restrain and dimi-
nish in proportion to the population, the annual number of births, and in a still
greater degree that of deaths? on the contrary, a great number of births, equal-
led or even exceeded by that of deaths, is a characteristic sign of state of bar-
barism. In the former case, as man in a mass reach the plenitude of their phy-
sical and social development, the population is strong, intelligent and manly;
whilst it remains in perpetual infancy where generations are swept off without
being able to profit by the past, to bring social economy to perfection."
51. Statistics of Lithotomy at the Hospital of Incurables, at Naples, for thirteen
years. By Saxvatore de Rekzi, M. D.
OPERATED ON.
Cured.
Died.
AGE.
Years.
Men.
Women.
Infancy.
Manhood.
Old Age.
1821
- 27
.
0 -
23
- 4
12
.
11
_
4
1822
- 28
_
0 .
26
- 2
12
>
12
.
4
1823
- 38
-
1 -
31
- 3
14
.
15
-
5
1824
- S5
-
2 -
32
- 5
15
_
16
-
6
1825
- 38
_
0 -
26
- 4
14
.
15
.
1
1826
- 35
.
2 -
32
- 5
17
.
17
-
2
1827
- 18
.
1 -
12
- 7
7
.
9
-
3
1828
- 25
.
0 -
19
- 6
10
_
14
.
1
1829
- 35
-
1 -
31
- 5
16
>
18
.
2
1830
- 32
-
3 -
29
- 6
15
-
17
_
3
1831
- 31
_
1 -
39
2
17
_
12
-
3
1832
- 22
-
0 -
17
- 5
14
-
6
.
2
1853
- 38
-
1 -
33 ■
- 6
23
-
10
-
6
Totals. 389 12 341 60 185 174 42
The whole number operated on is thus 401, of whom 60 died, 14 96-100 per
cent, or 1 in 7 nearly. In this number, there are comprised two operated on
by the method of Scarpa; all the others were operated on by the lateral method
modified.
The period during which the patients had laboured under stone, varied from
three months to sixteen years. The time of cure was from six days to a month.
In 1827, an epidemic verminous fever broke out, which destroyed more than a
third of those operated on.
In the bodies of the dead, traces of anterior diseases of the kidneys, bladder,
or intestines, were almost always found.
The above table relates to those operated on in the hospital, who are all
poor, badly nourished, and badly nursed. The rich are operated on at their
own homes.
Every surgeon has a right to operate at the hospital, except one who has
been prohibited on account of his proved unskilfulness. It is on that account
that the mortality rises to 1 in 7, for skilful surgeons lose only 1 in 20, and M.
Petrunti has lost only 1 in 25.—Gaz. Med. Feb. 1834.
CHEMISTRY.
52. New .Alkaloids. — Sarsaparilline. "This substance (says M. Thubeuf) is re-
garded as the active principle of sarsaparllla. Like the original root, it commu-
nicates to water the property of frothing when agitated, and gives it that sharp,
bitter taste which we find in the aqueous or alcoholic infusions of sarsaparllla.
When examined by the microscope, it presents radiated crystals, the layers of
Chemistry. 517
which converg-e toward their extremities, and it has no action whatever upon
turnsole paper. Sarsaparilline, when pure, is white, without odour, and, if it con-
tain no water, is tasteless. It is little soluble in cold water, but the whole is
taken up by boiling- water, which throws it down ag-ain as it grows cold. It is
soluble in alcohol, either cold or warm, and the substance may be crystallized
in this manner by evaporation. It may be precipitated from its alcoholic solu-
tions by the addition of a little cold water. This alkaloid is insoluble in ether,
even at the boiling point, but is very easily dissolved in a warm mixture of alco-
hol and ether in equal quantities.
*^ Atrophine. — This substance, (says MM. Geiger and Hesse,) already noticed
by Brande, has been obtained from the Atropa belladonna. It has presented
identical properties wlien obtained Irom the same part of the plant by dif-
ferent processes. It is white, and crystallizable into bright, transparent prisms,
which have a tendency to group together; at the ordinary temperature, water
takes up only a hundreth part of the mass. The aqueous solution of atrophine
renders turnsole paper blue, when reddened by an acid. It acts on the organ
of vision in the same way as belladonna, and even a very weak solution is suffi-
cient to dilate the pupil, which remains in that state for a considerable time.
Chlorine has very little action upon it, and it seems to form sub-saline compounds
with the acids. The aqueous infusion of atrophine forms an abundant white
precipitate with the aqueous infusion of galls, and it forms an orange-yellow
precipitate with the hydrochlorate of gold.
•* Hyosdamine. — This alkaloid is most easily obtained from the seeds of the
Hyosciamus niger. It crystaUizes into transparent, colourless needles. Its taste
is acrid and disagreeable, like that of tobacco, and it has a powerfully poison-
ous action. The smallest quantity, placed on the eye, produces permanent di-
latation of the pupil; in an anhydrous state it is not alkaline, but becomes so
by the addition of a small quantity of water. The salts of hyosciamine are neuter,
they are partially crystallizable, and are as poisonous as the plant itself.
** Daturine. — This alkaloid has been extracted by the same chemist from the
Datura stramonium. It readily crystallizes into regular prisms, which are colour-
less and brilliant. It is inodorous. The taste is at first slightly bitter, and then
becomes very acrid like that of tobacco. Daturine is a highly poisonous sub-
stance; one-eighth of a grain was enough to poison a sparrow in three hours.
When placed on the eye, it occasions a strong and permanent dilatation of the
pupil.
•* Solanine. — This substance, already discovered by several French chemists
in the Solanum nigrum, Solanum dulcamara, and the Solanum mammosum, has
been recently found in the potato by M. Otto of Brunswick. He obtained the
alkaloid in the following manner: — The potato buds were first treated in water,
acidified by sulphuric acid; he then separated the sidphuric and phosphoric acids,
with the extractive matter, by acetate of lead; the colourless liquor which re-
mained was saturated with lime water, and the precipitate boiled in alcohol; and
the product thus obtained was purified by frequent washing in alcohol. In order
to determine its action on the animal economy, M. Otto tried the effects of this
substance upon rabbits, and found that it should be ranged amongst the acrid nar-
cotic poisons. One grain of solanine was sufficient to kill a rabbit in six hours;
a second rabbit, which was much stronger than the former, was destroyed in
nine hours after having taken three grains. It exercises a remarkable paralyz-
ing effect on the hinder extremity of the animal before occasioning death, and
this paralysis may be produced in horned cattle, by simply feeding them on the
washings of potato-tops. This substance is white and powdery, and turns blue
turnsole paper which has been reddened by the action of an acid. The greater
part of its salts assumes an aspect like gum upon desiccation.
" Colchicine. — This alkaloid crystallizes into delicate needles; its flavour is
very bitter; when placed in the nares it does not excite sneezing, while the
smallest portion of veratrine occasions a violent fit. Colchicine is a strong
poison; one-tenth of a grain dissolved in alcohol was given to a cat six weeks
No. XXVIIL— August, 1834. 44
518 QUARTERLY PERISCOPE.
old; the aiilmal began at once to foam at the mouth:
she passed abundant alvine evacuations, and vomited; she soon became feeble,
unable to walk steady, fell down on the ground, rolled about, and was agitated
by convulsive motions; these symptoms increased in severity; the anim.al died
in twelve hours. On examining the body after death, the intestinal canal was
found to be violently inflamed, and blood was effused into its tissue through the
whole extent; one-twentieth of a grain of veratrine was given to a younger cat,
in order to judge of its effects by comparison; they were very inergetic; the ani-
mal quickly became feeble, was seized with convulsions, fell on the ground, and
died within ten minutes. After death nothing remarkable was discovered ex-
cept inflammation at the upper part of the oesophagus. This portion of the canal
was not inflamed in the cat poisoned by colchicine.
'' Aconitine. — M. Geiger has found this alkaloid in the leaves of the aco-
nitum napelius; it does not seem susceptible of crystallization. When perfectly
pure, it is wliite, grained, and forms a colourless, transparent mass. Its taste is
bitter, then acrid, but the acridity is not strong or permanent. In this respect
it differs from the plant, whose taste often remains twelve hours, leaving the
tongue quite benumbed. The acrid principle is united with the aconitine, from
which it may be separated by repeatedly combining the alkaloid with acids.
When this substance is completely deprived of the acrid principle, it is exces-
sively poisonous; the one-fiftieth part of a grain, dissolved in alcohol, was suffi-
cient to kill a sparrow in a few minutes, and one-tenth of a grain destroys a
small bird with the rapidity of lightning. When placed on the eye it produced
dilatation of the pupil, but the effect is o^ short duTixixon."— Journal de Pharma-
cie, February and March, 1834.
53. iVeiy Researches on the Composition of the Serum of the Human Blood. By
F. BouDET. — The object of these researches is to determine the nature of the
relation between the globules of the blood and the colouring matter and the se-
rum, and to ascertain the chemical constitution of the latter fluid. M. Boudet
takes a general view of all the representations which have been given of the
nature of the globules, from the time of Leeuwenhoeck to that of Hewson,
Home, Prevost and Dumas, Young, and lastly, Raspail, Donne and Muller. It
is well known that Hewson represented the globules as fiat orbicular or circular
bodies, like coins, but with prominent centres, and that the observations of Pre-
vost and Dumas are in favour of the same idea. Home, on the other hand, in-
ferred, from what he conceived careful microscopic observation, that they were
minute spherical bodies, consisting of a central globule, enveloped in colouring
matter during life. This idea was also maintained by Young, who considered
the central umbilicus or prominence as an optical illusion.
The general tendency, in short, of different observations on the constitution
of these minute and problematical bodies appears to be, that they consist of two
concentric spheroids. The separate and essential existence of the inner sphe-
roid appears to be established, especially by the experimental observations of
MM. Prevost and Dumas, and M. Donne and M. Muller. Thus the first inquirer
found, that, if dried blood was diluted in a saline solution, the central globules
were easily recognised; and that, conversely, when the blood was diluted with,
pure water, the colouring matter was dissolved, or rather divided in this fluid,
and the internal spheres appeared then to be colourless. Donne found, among
numerous microscopical observations, that whether he operated on human blood,
or that of the frog, the globules were effaced, indeed, when diluted with water
on a glass plate; but that, if he waited till the colouring matter had spread over
the margins of the plate, he then observed these globules colourless and trans-
parent floating in the fluid, and that it is absolutely impossible to dissolve them
in a large quantity of water within a space of more than twenty-four hours. M.
Donne, in short, regards the globules as minute bodies of a lenticular shape,
formed of a fundamental tissue of fibrine, in the interstices of which albumen
and colouring matter are deposited.
Chemistry. 519
Lastly, in a letter recently addressed to the Institute, and inserted in the An-
nales des Sciences Naturelks, ('October, 1832, p. 222,) M. Muller adds the follow-
ing confirmatory statements, derived from the blood of frog's. "I'he globules
of blood are composed of a colourless nucleus and red crust, which undergoes
gradual solution in pure water, but not in salt or sugared water. After the so-
lution of the red crust in water, the central nuclei remain insoluble in simple
water, but are dissolved in alkaline water. The most effectual mode of detach-
ing these nuclei from their red capsules, is to mix a drop of acetic acid with a
drop of blood from a frog, or any other animal, and to observe the effect micro-
scopically. The red crust is instantly dissolved in the acetic acid, while the
elliptical nuclei remain, and may be examined in their proper form."
From all these testimonies, combined with his own observation, M. Boudet
infers, that, whatever discordance prevails on other points, it is certain that the
globules of the blood consist of two substances — a colourless and a red colour-
ing matter, and that in configuration they form two concentric spheroids. To
us it appears from the facts more natural to represent thenn as consisting of a
central spheroid, and an inclosing spheroidal capsule — both concentric.
On the diameter and size of these globules, M. Boudet merely repeats the in-
ference formerly established by several observers, that though these diameters
vary in different species, and much more in diff"erent animals, they are invariably
the same in the same animal. This might demonstrate the impropriety of trans-
fusing the blood of an animal of one species into the vessels of an animal of a
different species. The odorous principle of the blood, he is of opinion, depends
on the presence of some volatile acid substance, analogous to those vi^hich were
found by Chevreul in adipose substances. This opinion derives some probability
from the fact, that M. Matteucci, in distilling the serum of goat's blood with sul-
phuric acid, obtained a mixture of lactic and caproic acid.
On the important question, as to the state in which the fibrin exists in blood,
M. Boudet rejects as untenable, the common opii\ion, that this principle forms
part of the globules, partly in consequence of the experiments of M. Le Canu
on the colouring matter of the blood, and partly by reason of the experiments
of M. Muller, which are entirely at variance with such a supposition.
This observer maintains that the fibrin in the coagulable part of the blood is
not contained in the globules, but is dissolved in the serum. To demonstrate
this inference he selects the blood of recent frogs, the globules of which are too
large to pass through the pores of filters. Having amputated the thigh of a frog,
he causes the blood to fall on a moistened filter, and mixes with it an equal
quantity of pure water, or rather of sugared water. There escapes a clear liquid,
in which is quickly formed a clot of fibrin, which is speedily condensed and
becomes white. The globules in the meantime remain on the filter, unchanged
and undissolved if sugared water have been mixed with the blood. From this
experiment it results, that the coagulation of the blood is not justly explained
by referring it to aggregation of the globules. This experiment succeeds in
summer, spring, or autumn, but not in winter, because the blood of frogs does
not coagulate at this season.
These experiments, M. Boudet infers, concur in showing that the fibrin exists
in the serum in a state of solution.
M. Boudet has further detected in the blood, at least, its serums the presence
of three principles, — two entirely new, which had hitherto escaped analytical
examination; and he is led to express the opinion that, as it was only by ope-
rating on very large quantities that he discovered the principles alluded to, it
is necessary to have recourse to a new mode of analysis, as the circulation and
repair of the blood are so rapid that any given quantity taken at any particular
point of time may contain mere traces of the substances found to exist. He
further thinks, that, if examined in this manner, the blood must contain not only
the materials of all the organs, but even the characteristic principles of the dif-
ferent secretions, as cholesterine, urea, &c.
520 QUARTERLY PERISCOPE.
The substances next found in the hunnan blood by M. Boudet are, — 1, an al-
kaline soap;; 2, cholesterine; and 3, a fat substance hitherto unknown, and to
which he applies the distinctive name of seroline.
These substances were obtained in the following" manner,
A larg-e quantity of serwm, formed by the combination of three blood-lettings,
being dried by a gentle heat, washed by boiling water, and dried again, was
reduced to powder, and treated with boiling alcohol. The alcoholic liquors
which had been colourless, became turbid on cooling, and from them were pre-
cipitated very slowly white Jiocculi, separable by the filter. These flocculi,
which presented the aspect of little adipose pearly phites, slightly translucent,
but without crystalline form, were the new principle denominated seroline.
Viewed b)'- the microscope, these adipose whitish pearly plates seem to be
formed of filaments, swelling at intervals with minute white opaque globules,
which give them the aspect of chaplets or strings of beads.
Seroline melts at -|- 36° = 97° F. evinces no reaction on reacting papers,
and reddens, like cholesterine, in contact with concentrated sulphuric acid.
It does not form an emulsion with cold water, and if warmed it swims on the
surface of the fluid in the form of a colourless oil.
It is readily dissolved by sulphuric ether even in the cold. It is in no degree
affected, on the contrary by alcohol in the cold, and traces only are dissolved
in that fluid at 36° = 92° F. and at ebullition.
Subjected to warm aqua potassse. for six hours, it undergoes no change, and
hydrochloric acid causes no precipitate in such alkaline liquor.
Long heated with nitric acid it is not dissolved, but becomes soluble in aqua
potassse, which then acquires a brown colour.
Distilled at the lamp in a glass tube, it emits a very characteristic odour, fur-
nishes alkaline vapours, is partly volatilized, and leaves a carbonaceous residue.
The alkaline soap and cholesterine were obtained in the following manner.
The filtered liquor distilled in the sand-bath, and reduced to one-fourth of
its volume, exhibits, upon cooling again, a milky turbidity, yet without re-
markable precipitate.
The evaporation being continued, furnishes a residue of a yellowish-brown
aspect, of the consistence of turpentine, forming with cold water an emulsion
of a bitter taste, and a smell analogous to that of the phosphorated fat of the
brain.
This residue triturated cold with alcohol at 36° = 97° F. gave it a yellow
colour, and became attached to the tube in the manner of a soft resin. The al-
cohol was renewed till it ceased to acquire colour, and the mixture was then
separated into two distinct products; one soluble in alcohol, corresponding to
the only matter of M. Le Canu, the other insoluble in the fatty matter of the
brain.
From the first of these left to itself were precipitated, at the end of a certain
period, minute crystalline plates, of an appearance analogous to that of choles-
terine, and which, indeed, present no material difference of character from that
substance.
When the serum after this precipitation was decanted and evaporated to dry-
ness, it furnished a viscid residue of a bitter taste, very soluble in alcohol, and
retained some cerebral fat, which was afterwards detached as far as possible by
the aid of alcohol, at 22°= 72° F., which appeared to M. Boudet to exercise
no sensible influence on the substance. Lastly, he dissolved it in ether, which
separated from it some traces of saline matters.
Thus purified, this new product was soft, sensibly transparent, of a bitter sa-
ponaceous taste, a little altered by the taste of the phosphorated fat, very solu-
ble in alcohol and ether, sensibly soluble in water, cold or hot, and rendering
it mucilaginous, like a genuine soap, and speedily restoring the blue colour to
turnsol, reddened by acid. From these characters M. Boudet felt it impossible
to mistake this substance for an oily matter, and most probably in the shape of
Chemistry. 521
a g-enuine soap. He afterwards confirmed this inference by the addition of hy-
drochloric acid to the watery emulsion upon which drops of oil came to the sur-
face. He regards the soap as a probable mixture of oleic and marg-aric acids.
M. Boudet regards the oily matter of M. Le Canu as partly alkaline soap,
partly seroline and cholesterine. — Journal de Fharmade^ June, 1833, and Edin-
burgh Med. and Surg. Journ. Jprilt 1834.
54. Composition of Serum — Serolin. — M. Boudet remarks, that except the
saline constituents of the serum of human blood, and the extractive matters, im-
perfectly known by the names of ozmazome, impure lactate of soda, muco-es-
tractive matter, &c. the only well defined substances shown by analysis to exist
in the serum are albumen, the fatty matter of the brain, urea, and an oily matter.
M. Boudet did not examine the extractive matters dissolved by water from
dried serum, but only those products which were obtained from dried serum
by boiling- alcohol, after the water had dissolved such as were soluble in it.
Having obtained a considerable quantity of serum, dried it, and dissolved all
that was soluble in boiling water, it was again dried, and treated with boiling-
alcohol: the mixed alcoholic solutions were colourless. The mixture became
turbid by cooling", and deposited, though very slowly, white flocks, which were
separated by the filter; these had a fatty pearly lustre: they were not crystalline,
but small and slightly translucid plates. In M. Boudet's opinion these plates
constitute one of the principles of serum, and he calls it serolin. This substance,
when examined by the microscope, appeared to be formed of small filaments,
with small, white, opake globules, which gave them the appearance of strings of
beads; it fuses at about 134° Fahr.^ does not act upon test papers, but, on the
contrary, like cholesterine, it reddens concentrated sulphuric acid. It does not
make an emulsion with cold water; and if it be heated, it floats like a colour-
less oil on its surface. Sulphuric sether dissolves it easily, even when coldi on
the contrary, alcohol of 0.837 dissolves a trace of it Vv'hen boiling, and none
when cold. Heated for six hours in a solution of potash it suffered no change,
and muriatic acid added to the liquor produced no turbidness.
Neither muriatic nor acetic acid, whether cold or hot, produced any change
in this substance: when long heated with nitric acid it was not dissolved, but
became soluble in a solution of potash and rendered it brown.
Distilled by the lamp in a small glass tube, it emitted a very characteristic
odour, gave alkaline vapours and a light coaly residue; part of it seemed to vo-
latihze. The small quantity obtained did not allow of performing- more experi-
ments; but the above, M. Boudet thinks sufficient to establish serolin as a new
immediate principle, and to justify the name which he has given it.
The alcohol from which the serohn had been separated by the filter was dis-
tilled in a salt-water bath, and when reduced to one-fourth of its bulk, the dis-
tillation was stopped and the liquor allowed to cool. It soon became turbid, but
no material deposit was formed.
By continuing the evaporation in a capsule, a slightly yellowish brown resi-
due was obtained: it was of the consistence of turpentine, and formed an emul-
sion with cold water. Its taste was acrid, and its smell similar to that of the
phosphorized fatty matter of the brain.
This residue triturated with alcohol of sp. gr. 0.837, rendered it yellow, and
attached itself to a tube like a soft resin. Fresh alcohol was added until it
ceased to acquire colour, and two products were thus separated; one, soluble
in alcohol, was of course the oily matter already alluded to, and the other was
the fatty matter of the brain; this was insoluble in cold alcohol, but dissolved
by it when boiling, and in xther, except a very small portion of a rosy matter,
which was too minute for examination. It crystallized in briUiant laminae, did
not act upon coloured test papers, was unalterable by alkalies, made an emul-
sion with cold water; and its properties were perfectly similar to the cerebral
fat, as described by Vauquelin and Chevreul.
The alcoholic solution, exposed for some time to spontaneous eyaporation^
44*
522 QUARTERLY PERISCOPE.
gave small crystalline plates resembling' cholesterine in appearance. On com-
paring- their properties, it was found that they agreed nearly in their fusing
point at about 278° of Fahr.5 but they differed in this respect, viz. that pure
cholesterine is crystalline, while this substance was in flocks, and had no crys-
talline splendour: this difference, however, appeared to depend upon its re-
taining- a little phosphorized fatty matter, the odour of which it retained; and
on mixing pure cholesterine with this substance, the mixture had the same pro-
perties as the supposed cholesterine of the blood. M. Boudet admits, however,
that further experiments are required to ascertain positively that the serum of
the blood contains cholesterine.
After the separation of this supposed crystallized cholesterine, the alcoholic
solution was evaporated to dryness; it furnished a viscid residue, of an acrid
taste, and soluble in alcohol. It still, however, retained cerebral fatty matter,
which was separated as much as possible by alcohol, of sp. gr. 0.915, this ap-
pearing to have scarcely any action upon it: lastly, it was dissolved in aether,
which separated from it traces of saline matter.
Thus purified, this new product was soft, somewhat transparent, of an acrid
and soapy taste, slightly altered by phosphorized fatty matter, very soluble in
alcohol and aether, and sensibly dissolved in water either cold or hot, and ren-
dered it frothy like a true soap. Lastly, it restored the blue colour of litmus
reddened by an acid; it appeared therefore to be a true soap. To decide this
question, it was dissolved in hot water, and a few drops of muriatic acid were
poured into the solution: abundant flakes were separated from a transparent
liquid, and melted at the surface with the appearance of an oil. This oil after
washing with hot water, retained no muriatic acid, reddened moistened litmus
paper strongly, made no emulsion with water, and dissolved rapidly in alcohol
and aether, rendering them acid: it immediately combined with soda, and re-
produced a solution resembling common soap: it was probably a mixture of
oleic and margaric acid.
M. Boudet remarks, that numerous attempts have been made to discover bile
in the blood, and he further states that the existence above described of an al-
kaline soap, and probably of cholesterine, show that bile, or the various sub-
stances of which it is composed, are actually found in the blood. — The London
and Edinburgh Philosophical Magazine, &c. February, 1834, et Ann. de Chim.
et de Phys. torn. Hi. p. 337.
55. Presence of Azote in all Seeds. — It was known that some seeds contained
azote; wheat is a striking example of this, since it furnishes gluten, a substance
containing a large proportion of azote; but no one has hitherto announced that
all seeds contain an animalized matter.
M. Gat-Lttssac, has subjected a great number of seeds both in their natural
state and deprived of their husk, to dry distillation and he has not found any
which does not yield ammonia, either immediately or on the addition of some
lime.
Many seeds, as rice, yield on distillation very acid products, whilst beans
and most of the leguminous seeds furnish very ammoniacal products; but on ad-
ding lime to the former, the presence of ammonia is readily demonstrated.
From this M. Gay-Lussac concludes that in general, a grain without its enve-
lope, may be considered as formed of two parts, one vegetable, which yields an
acid product; the other animal yielding an ammoniacal product. Thus the
acid or alkaline character of the product depends upon the predominance of
one of these two matters over the other. — Annates de Chimie, May, 1833,
( 523 )
AMERICAN INTELLIGENCE.
Medical Education in Georgia. [Extract of a Letter from Paul F. Eve, M. D.
Professor of Surg-ery in the Georgia Medical College, to the Editor.] — With res-
pect to the state of our profession in Georgia of which you requested me to in-
fornTi you, I will observe that we hope a favourable change is about to be ex-
ercised by our medical college in this place. Six years ago a medical institu-
tion was attempted here under the appellation of a Medical Academy, by Dr.
Antony, now our professor of midwifery. This not succeeding, or at least not
being encouraged by a reciprocity of favours from the medical institutions of
our country, the charter was extended by the legislature of 1829-30, to the
power of granting diplomas under the same requisitions as other medical col-
leges. As a college, the first course of lectures was delivered by the six pro-
fessors in the winter of 1832-3. Our class consisted then of twenty-eight or
twenty-nine students. Four alone of that number were candidates, and the
degree of M. D. was conferred upon them by our president last April. At the
request of our friends, the application, (onaccountof the excitement in politics,)
for pecuniary aid to the legislature, was withdrawn for this year. Our second
session opened with a class of thirty-five — one of whom was virtually expelled
the college during the course of lectures for immoral conduct; eighteen were
expected to become candidates for the degree; seventeen however, only handed
in theses. Of this number fifteen passed a satisfactory examination.
Our last legislature liberally endowed us with $ 10,000 cash, and land to the
value of about $5,000 more. We have $5,000 from the city council for our
services to the city hospital for ten years— and a lot has been given us on which
our building is now being erected. Besides this, the faculty have raised $ 6,000,
and have despatched it with an agent. Professor Dugas, to Europe, for appa-
ratuses, &c. &c.: and another professor expects to leave here during the summer
for the north to increase our chemical apparatus, and to attend to the interior
arrangements of our building. The plan we have adopted is Grecian doric,
seventy by seventy-six feet; six fluted columns, portico, dome and stucco-work.
Two lecture rooms on first floor with laboratory and library; one above, with
museum, dissecting room, &,c. The contract is for the sum of $ 14,650; to be
in readiness for the reception of the class in October next, and completed by
1st of next March.
Besides this medical college, we have a board of physicians which assembles
annually at the seat of government in Milledgeville, whose duty it is to examine
candidates for licences to practice medicine and surgery in the state. This body
has the power to examine a candidate even with a diploma. It is thought, how-
ever, our penal code is deficient on this point; we have still quacks among us,
but comparatively few. An application from the Thomsonians last winter was
ridiculed in our legislature, and I believe the publication with respect to the
licence to practice in the state, induced the well-known impostor Whitlaw, to
leave our city quite suddenly.
As the graduates of our first commencement were not furnished to you, and
were not published, I will first give you a list of them for the Journal, and if
you can find room for them in the next number, you will very much oblige us
and your humble friend.
At the first commencement of the Medical College of Georgia, held the Ifth
524 QUARTERLY PERISCOPE.
of April, 1833, in Augusta, the following* g-entlemen having complied with the
requisitions of the institution received their diplomas.
Edward A. Eve, of Georgia, on Dyspepsia.
T. W. GrimeSy of Georgia, on Dysentery.
Isaac Boiven, of Georgia, on the Blood, in Greek.
J. M'D. Borders, of Georgia, on Asthma.
At the commencement held in the Baptist Chapel on April the 16th, 1834,
in Augusta, the following gentlemen received the degree of doctor of medicine.
A. W. Jonest of Georgia, on Revulsives.
M. TV. PeterSy of Georgia, on Bilious Fever.
B. D. Brewster, of Georgia, on Gastritis.
William Gilbert, of South Carolina, on Pleurisy.
D. Day, of Georgia, on Scarlatina.
/. C. Cobb, of New York, on Injuries of the Head.
Y. B. Olive, of Georgia, on Dropsy.
Jon. Toole, of South Carolina, on Remittent Fever.
James M^Lester, of Georgia, on Indigestion.
S. H. Brewster, of Georgia, on Goitre.
/. W. Earle, of South Carolina, on Typhus Fever.
Horace Nelson, of Ireland, on Medicinal Effects of Cold.
E. W. Richardson, of Georgia, on Syphilis.
Ji. B. Greene, of Georgia, on Asiatic Cholera.
Paul II. Earle, of South Carolina, on Hydrocyanic Acid.
Dr. Brewster proposes pressure for the cure of goitre; by means of two
springs coming from back of neck with pads so as to operate laterally upon the
tumour, and lift it as it were from the trachea.
Dr. Paul H. Earle's experiments with the prussic acid have led him to fear
bad effects from a dose of seven drops, prepared after the method of Scheele;
he has himself taken that quantity, but laboured under unpleasant symptoms
for some time.
Augusta, April 17th, 1834.
Case of Spinal Irritation. — The following case possesses peculiar value, from
the relator. Dr. Andrew Nichols, of Massachusetts, being himself the subject
of it. " To the correctness of Teale's essay," remarks Dr. N. *' so far as it de-
scribes my own case, I can bear the most decided testimony. Several of the
symptoms are common to this and other very different diseases; but, whenever
we meet with any of these symptoms, the spine should be carefully examined,
and, if a tender spot or spots be found, this tenderness must be cured before
we can remove the complaint. If the disease should prove complicated, then,
indeed, even removing this tenderness may not cure, although it will probably
greatly alleviate the suffering and pain. In regard to the means of doing this —
leeching, cupping, and blistering — recommended by Teale, I can also speak
decidedly in favour of their efficacy. At a time when both my arms were so
lame and painful that I could use them only with the greatest difficulty, four
leeches, applied to the lower vertebrae of the neck — even before they dropped
off — removed this lameness almost entirely. Like effects followed cupping and
blistering. But the irritation would soon return, and acquire a repetition of the
remedies. In this way the complaint was kept in check, but little, if any, pro-
gress was made towards recovery. Teale does not tell us the cause of this,
which I soon found to be the following of one of his own directions — the con-
fining myself most of the time to a horizontal position! — the real cause of the
sudden return of the irritation, being coniinned pressure on the spine. The suf-
ferer from this disease cannot lie long on his side, because the nerves of the
Jimtrican Intelligence, b2^
arms, sides, hips, or lower extremities — the seat of the neuralgia — cannot bear
pressure, but are made immediately painful by it. Hence the patient involunta-
rily turns on his back— pressure is consequently made on the seat of the dis-
ease; but, as this part is seldom the seat of much pain, the mischief is not rea-
dily discovered. He" perhaps, if worn out with watching-, sleeps. The spine is no
long-er relieved by the little motion he gives himself while awake. The pres-
sure is continued perhaps an hour or two 5 and he awakes with all his neuralgic
affections aggravated in a tenfold degree. It is only by the greatest effort that
he can change his position. His back is still the easiest part; but there is acute
pain, numbness, soreness, and all the protean forms of neuralgia, tliroiighout
the course of the nerves, which proceed from those tender parts of the spine,
suffering from pressure. Having satisfied myself of these facts, it became my
study to protect the spine from pressure. By the careful adjustment of feather-
beds and pillows, while awake and on my guard, a tolerably easy position could
be obtained and preserved for a short time. But sleep would invariably disturb
this comparatively easy position, permit pressure on the tender parts, and re-
store the irritation and all its consequent mischiefs. I was therefore compelled
to consider the direction in the books, for confining the patient to horizontal
position, erroneous. I now sought relief by sitting up as much as possible.
Such became my dread of the bed, from the increased uneasiness which inva-
riably met me there, that for several days I sat up eighteen out of the twenty-
four hours. OEdema of the lower limbs came on, for the relief of v/hich recourse
was had to bandages. In this way, by continuing- the blisters and leeching, I
slowly gained on the complaint. In the mean time, I had turned my attention
to Dr. Arnott's hydrostatic bed — believing- this, if, in reality, ail that the jour-
nals describe it to be, the all -important means of curing- this complaint in the
most expeditious manner. I accordingly put in motion a train of operations,
which, on the 27th ult. put me in possession of one in complete order. It proved
all that I had anticipated. At nine o'clock, P. M. I threw myself upon it, and
laid more at my ease than I had been in any position since my confinement, for
nearly twelve hours — having had during- that period nearly six hours of quiet
sleep, without any increase of neuralgia. From that hour I have found myself
constantly and regularly improving-. Leeches or blisters have not since been
used. The whole extent of the spine has been well rubbed twice a day with
the following- liniment: — R. Tr. opii, 01. oliv., 01. terebinth. — equal parts.
"The lameness of my limbs is nearly removed. The urine, which, up to March
1st, had been during my confinement high-coloured, depositing a thick sedi-
ment, resembling- brick-dust, and which stained the white earthen vessel in
which it stood a short time, of a bright crimson colour, is now clear, and no
longer deposites any sediment. I have indulged my appetite with a tolerably
generous diet. Food digests well, which, by the way, has been the case through-
out— having always relished food, excepting occasional periods of nausea from
medicine. The antiphlogistic regimen was, however, rigidly adhered to until
after the hydrostatic bed was obtained.
"I am now convalescent, gaining strength hourly. In reviewing the history of
my case, I am inclined to attribute the commencement of spinal irritation to a
sudden injury of the back, by jumping down from a block about two feet high,
upon the ground. A sudden pain seized me in the back, which remained con-
siderably lame for several days.* From this time some trifling soreness about
the sacrum, lameness of the hips and shoulders, was felt daily. This, however,
was but little noticed. During the last week in January, and the first week in
February, these symptoms were gradually aggravated, and attendance on my
various professional and other duties, became irksome, and I felt myself com-
pelled to give them up. I now used liniments to the limbs, took purgatives,
colchicum, and other medicines, for rheumatism — lounged on sofa, easy chair,
or bed — grew constantly worse — no care being taken to preserve the spine
* " This happened about Christmas."
526 QUARTERLY PERISCOPE.
from pressure: for, as yet, although I had a knowledge, doubtless somewhat su-
perficial, of irritation of the spinal marrow, and occasionally practised accord-
ing to the recommendation of the authors above quoted, strange as it may seem,
I was permitting this disorder to make dreadful inroads on my own health and
comfort, without even a suspicion of the true cause. And when, from a hint
from Dr. A. L. Pierson, the truth burst in upon the mind, another week was
nearly lost, in consequence of keeping a recumbent position on a feather bed.
Hard and slow the progress towards recovery was made by sitting up most of
the time, until the possession of the hydrostatic bed removed the chief obsta-
cles to recovery. After the discovery of the true nature of my case, 1 abandon-
ed the use of internal medicine altogether, satisfied that the curative process
could not be materially advanced thereby. It would seem that the public have
not yet realized the immense importance of Dr. Arnott's invention — have not
yet perceived its very general application to the relief of all, who, from any
cause, are compelled to assume, for days or weeks, a recumbent position. The
medical journals, so far as I have seen, have only given Dr. Arnott's modest ac-
count of the uses to which it may be applied, without recommending the in-
vention, as it deserves. But when we consider of how great importance ease of
position must be to almost every curative process — be it of a broken bone,
acute, or chronic disease — the hydrostatic bed becomes, so far as human com-
fort is concerned, the most important invention of the age.
*' The vast number and form of diseases, arising from irritation of the spinal
marrow, and ganglia of the sympathetic nerve, and the probability that a great
number of other diseases, such as fevers, &c. often become complicated with,
and rendered fatal by spinal as well as cerebral irritation, caused, perhaps, by
confiinement to beds, which, instead of giving rest, irritate the spine, by too
constant pressure — render it highly probable that the hydrostatic bed will, as
soon as its value is generally known, save many lives, and an amount of human
suffering vastly greater than imagination has yet conceived. Besides, even for
the healthy it is a most luxurious bed — warm, dry, and easy. In point of com-
fort, it so far exceeds all other couches, that it will be strange indeed, if it
should not come into extensive use for the common purposes of rest."
Tumours of the Neck. By N. R. Smith, M. D. Professor of Surgery in the
University of Maryland. — Case I. The remarks of Allan Burns on tumours of
the neck and the practicability of their removal in certain cases, appear to me
to inspire the young surgeon with too much dread of resorting to the knife in
such ifistances. The situation of tumours in relation to the fascia of the neck,
has, in my opinion, been too much regarded in determining the question of their
removal. Mr. Burns perhaps, being the first to demonstrate particularly these
expansions, was naturally disposed to make them of as much importance as pos-
sible in a practical point of view. From his remarks we should infer, that when
a tumour is situated below the deep lamina of the cervical fascia, it can not
have continued long and acquired any considerable magnitude, without es-
tablishing serious connexions with the important organs of the particular region
in which it may chance to be located. This is undoubtedly true with regard to
those tumours which speedily impart their peculiar nutritive actions to the sur-
rounding parts; but by no means so in regard to those which are enclosed in
cysts. I have often known them to be so forcibly pressed against other organs
as to receive the i.mpression of them without establishing any adhesion. I am
satisfied from my own experience in the removal of such tumours, that the cau-
tion of Mr. Burns relative to their extirpation when they chance to be situated
beneath the fascia, is far too strongly expressed.
In the vi'inter of 1830, I visited Mrs. Gilliland, aged about twenty-five years,
the wife of a farmer living near Gettysburg, Pa., for the purpose of examining
a large tumour situated in her throat. I found it to be located on the right of
the thyroid cartilage, under the border of the sterno-cleido-mastoid, and having
the omo-hyoid muscle strained directly across its centre. It was of course com-
American Iniellip-ence. 527
"O
pletely beneath the deep fascia, and was in innmediate contact with the sheath
of the great vessels. Its form was ovoidal, its size that of a larg-e goose's eg-g",
and it occupied nearly the whole space from the angle of the jaw to the clavicle,
creating great deformity. Its long diameter corresponded to the length of the
mastoid muscle. It was very firmly bound down by the mastoid muscle and
fascia, and was moved with great difficulty beneath them. I first satisfied ray-
self that it was no portion of the th3^roid gland. I also convinced myself that it
did not involve in disease the great vessels and nerves of the neck. That by its
mechanical pressure it irritated these organs was sufficiently manifest, for there
existed a train of symptoms evidently resulting from mechanical pressure on
the pneumogastric nerve. The stomach was much impaired in its function?,
her appetite being capricious, and food often occasioning much distress in the
organ soon after being taken. She was also sometimes affected with nausea,
diarrhoea, alternating with costiveness. There was also not a litlle embarrass-
ment of respiration. She suflTered severely with occasional pains in the head,
on the side corresponding to the disease. The pulse also gave evidence of con-
siderable constitutional irritation.
The tumour had an elastic feel, which caused me to doubt whether it was en-
cysted or sarcomatous. I am not positive as to its duration, but my impression
is, that it had been several years in arriving at the magnitude then present.
After a careful examination of the case, in association with my friend Dr. Ber-
luchy of Gettysburg, we decided that the extirpation of the tumour was in all
probability practicable, and I expressed a willingness to undertake it; not with-
out much apprehension, however, on account of its relations to the deep fas-
cia, blood-vessels, and nerves. The patient and friends immediately assented to
the proposition.
I commenced the operation by incising the integuments and platysma mus-
cle along the border of the sterno-cleido-mastoid muscle to the whole extent
of the tumour. Dividing the fascia of the neck, I encountered the omo-hyoid
muscle, drawn like a ribbon obliquel)^ across the tumour. From its extreme
tension I found it necessary to divide it, and thus the tumour and its immediate
coverings were completely exposed. I then carefully, with the director and
knife, divided many layers of cellular tissue which enveloped it, and at length
exposed the proper cyst of the diseased mass. This fortunately I found to be
but little adherent to the surrounding part. I was enabled, indeed, to effect its
division to a great extent by the use of the handle of the knife alone, occasion-
ally, however, finding it necessary to divide a band of cellular tissue. The tu-
mour had kept itself perfectly distinct from the surrounding parts, which
every where presented a perfectly healthy appearance. On dissecting it care-
fully from its bed, I found that it had been so firmly pressed against the great
vessels, and against the cartilages of the larynx, that it had received distinct im-
pressions from them. The great vessels were lodged in a furrow on its inner
and posterior part, but were separated without any considerable difficulty. I
found it necessary to secure no artery until 1 had removed all its connexions
except a small pedicle of vessels which attached it to the deepest part of the
wound. These I included in a ligature, and then divided them.
On the removal of the tumour, an immense chasm presented itself in the
throat, the cartilages of the larynx were completely exposed, and the great
vessels stripped from near the clavicle to the angle of the jaw. I closed the
integuments by means of three interrupted sutures assisted by adhesive strips,
and brought the parietes of the wound into contact by means of an elastic com-
press. The tumour presented, on di.ssection, the medullary sarcomatous cha-
racter.
The patient necessarily suffered severely during the operation, but 1 left her
soon after in a more comfortable condition than might have been expected. As
T subsequently learned from Dr. Berluchy, she recovered rapidly. A great part
of the wound healed by the first intention, and the cicatrix formed in such a
manner as to cause but little deformity. Those symptoms of gastric disorder
52S QUARTERLY PERISCOPE.
and constitutional irritation, which I had supposed to arise from the mechanical
pressure of the tumour, totally disappeared. She recovered health and strength,
and subsequently became the mother of a vigorous child. She still remains in
good health.
Case 2. — Mr. Winrotte, of Littlest© wn, Pennsylvania, a farmer, aged about
forty-two, became a patient of the Baltimore Infirmary, in the winter of 1828,
on account of a large tumour located upon the side of the throat, and circum-
stanced almost precisely as the last described. Its form and size were almost
precisely the same, and like it, it was covered by the anterior border of the
mastoid muscle and by the omo-hyoid. Symptoms extremely like those pre-
sent in the case of Mrs. Gilliland, were present in this instance. Deglutition,
however, was more seriously affected, owing as I thought to the greater degree
of power with which the muscles urged the tumour upon the trachea and larynx.
On a careful examination I became satisfied that the removal of the tumour
was practicable. My friend, professor Davidge, however, was rather averse to
such an attempt, and cautioned me in regard to it. The patient was desirous
that it should be performed, and I determined to proceed. The operation was
executed, (in presence of the medical attendants and pupils of the infirmary,)
in a manner almost precisely similar to that described in the last case. No blood-
vessels of any considerable magnitude were divided, and but a single ligature
was necessary. Much pain in tha region of the wound followed the operation,
and great difficulty of deglutition. These, however, subsided after a few hours,
and the condition of the patient become comfortable. He left the infirmary in
about a week after the operation, the wound having nearly healed. I saw him
some six months subsequent to this, and there was then present no appearance
of disease whatever. The tumour proved to be the medullary sarcoma.
After the lapse of about a year from the time of the operation, I learned by-
letter from his medical attendant, that a tumour of forbidding appearance had
presented itself in the cicatrix which had resulted from the operation. I was
soon after requested to visit him, and to attempt the removal of the disease
once more v/ith the knife. But I found the tumour presenting a totally differ-
ent aspect from that which it was in the previous instance. It was now hard,
knotted, closely adhering to the surrounding parts, and excessively painful. I
could not by any means withdraw it from its vicinity to the great vessels and
nerves, and any attempt to do so caused great pain. I attributed this, however,
in some measure, to the adhesions which the cicatrix had caused. He suffered
almost constantly, extreme pain in the head, shooting up from the region of
the tumour along the course of the great vessels and nerves. There existed a
great degree of gastric disorder, and not a little embarrassment of respiration.
He was now suffering great constitutional irritation, his strength and flesh were
rapidly wasting, and it was manifest that unless speedy reUef was rendered, the
case must soon come to a fatal conclusion.
I expressed doubt with regard to the practicability of the removal of the tu-
mour, because of its close adhesion to the surrounding parts, and the symptoms
indicating involvement of the blood-vessels and nerves of the neck. I deter-
mined, however, to make an incision upon it — to ascertain its connexions, and
then to effect its removal if practicable. Accordingly, in the presence of my
friends, Drs. Shorb and Miller, and several of my pupils, I divided the integu-
ments on the inner side of the cicatrix, and proceeded to explore its connexions.
After cautiously dissecting it from the muscles, and separating its external con-
nexions, I introduced the finger into the wound, and made gentle efforts to de-
tach and separate the tumour from the vessels. While I was in the act of doing
this I felt something give way to a gentle effort of the finger, as if some soft
substance were ruptured by it, and instantly the wound, the table, and the floor
was deluged with dark blood.
I immediately discovered that the internal jugular vein had become involved
in the disease, and that its coats, having become soft and brittle, had been
largely rent by even the slight traction which had been made upon them. The
American Intelligence, 529
vessel appeared also to have become enlarged, and, as by the struggles of the
patient, the irregularity of breathing, and the action of the heart, the blood was
pressed with great force from the cava into the jugular, the iiBemorrhage was
truly appalling. Haemorrhage from the carotid, I am confident could not have
been so rapid. It bubbled so copiously from the wound, that in an instant, and
before I could press my thumb into the bottom of the cavity, the floor was
covered with blood, and the patient fell back inanimate, and as if dying. Res-
piration and circulation being thus suspended, I was perfectly aware that in-
stant action, before any reaction should occur, was necessary to save our patient
from death on the operating table. I opened the wound more freely with the
knife. I removed the friable portions of the tumour — I exposed the vein, and
found it torn open down close to its junction with the subclavian. I then seized
an armed needle which was at hand, and at the moment that the patient was
reviving, and that blood began again to gush, I passed a strong ligature beneath
the vessel, and secured it close behind the clavicle. This was done with some
apprehension, lest I should include the pneumogastric nerve. After encircling
the vessel, however, I satisfied myself that the nerve was not included, and im-
mediately drew the knot. There was still a good deal of venous haemorrhage
from the upper orifice of the wound, and an oozing of arterial blood from the
remainder of the diseased medullary mass. It was manifest that the coats of
the artery also were involved and converted into the peculiar structure of the
disease, and that any further effort upon the latter would at once produce an
arterial haemorrhage. I therefore at once closed the wound, and applied to it
as the most efficient compress which could be used in that region, a soft sponge.
The bleeding immediately ceased, and slight pulse returned in the extremities.
The patient was carried to his bed, and although he suffered greatly, and was
much reduced, immediate dissolution was no longer threatened.
I was obliged to leave my patient, to return to Baltimore soon after the ope-
ration, but the conclusion of the case was related to me by Dr. Shorb, of Lit-
tlestown. He survived the operation about ten days, and then sunk apparent-
ly from exhaustion. It is manifest therefore that he could not have perished
from phlebitis, which by some is supposed almost necessarily to arise from tho
application of ligatures to veins of such very large size, and in a diseased con-
dition.
Another fact is worthy of particular notice. At the moment that blood was
gushing most copiously from the wound — when the patient was fainting, and
the inspirations were unfrequent, deep and strong, I distinctly heard a bubbling
of air as it was sucked into the vein. I apprehended at the moment, that im-
mediate death would be the consequence, but I am not aware that any parti-
cular morbid phenomenon resulted from it. — Baltimore Med. and Surg. Journ,
July, 1834.
Claims of British Surgery, to the Triumph of First applying a Ligature to the
Common Iliac with Success. — In an article in the Medico-Chirurgical Review,
for January last, (p. 278,) announcing the successful result of the case in which
Mr. Guthrie, on the 24th of August last, (1833,) applied a ligature to the com-
mon iliac artery, the editor observes, " thus this most formidable operation has
been successfully performed for the first time, and while it adds a wreath of
laurel to the brows of the distinguished surgeon, it exhibits a splendid triumph
of British surgery." Our cotemporary has been too hasty in claiming this
triumph for British surgery, and has placed the laurels on brows not destined
to wear them. The distinguished surgeon to whom the wreath justly belongs
is our colleague and countryman. Dr. Mott, who, upwards of seven years since,
(March 15th, 1827,) successfully applied a ligature to the common iliac, see
No. I. p. 156, of this Journal. Dr. Mott's patient, we learn, is still living.
It is not a little singular, also, that Mr. Guthrie, in his work, *' On the Dis-
eases and Injuries of Arteries," p. 365, should have recorded Dr. Mott's case as
No. XXYIIL— August, 1834. 45
530 QUARTERLY PERISCOPE.
fatal, more especially when he extracts the account of the operation from this
Journal, in which the entire restoration of the patient to health is explicitly men-
tioned.
Surgical Novelties. — Our friend, Dr. Vach6, of New York, writes to us that
Professor Mott has tied the left subclavian artery, for axillary aneurism, with
success. Also that the same distinguished operator has tied both carotids si-
multaneously, with the view of cutting off the circulation, and thus arresting the
growth of an enormous disease of the parotid gland. The patient survived
about twenty-four hours.
Dr. Mott has likewise extracted from a man an enormous calculus, measuring
nearly twelve inches in circumference, and weighing upwards of seventeen
ounces, avoirdupois. Every effort to crush and bore it having failed. Dr. M.
extracted it entire, and as it was as large as the lower aperture of the pulvis,
great violence was of course done to the soft parts. The case terminated fa-
tally on the fifth day. The patient had suffered many years, and was very
much reduced.
Table exhibiting the Doses and Properties ascribed to the Principal Medicines
and Officinal Preparations. For the use of the Materia Medica Class of the
University of Maryland. By Professor Dunglison. — This is a very convenient,
neatly arranged table.
Testimony to Professional Merit. — Certain citizens of Pine Ridge, Adams
county, Miss, have presented to Dr. Samuel A. Cartwright a splendid vase,
with a suitable inscription, as a testimonial of their sense of his eminent ser-
vices, in the year 1833, during the prevalence of cholera. — Natchez Courier and
Journal, May 9th, 1834.
Transylvania University. — 262 students attended the medical lectures in this
Institution during the session of 1833-4.
At a public commencement held on the 14th of March, 1834, 66 were gra-
duated Doctors in Medicine.
Medical College of the State of South Carolina. — The number of medical stu-
dents in this Institution during the session of 1833-4, was 103.
At the annual commencement 39 were graduated Doctors in Medicine.
University of Virginia. — Dr. Augustus L. Warin^er has been, we learn,
unanimously and unsolicitedly appointed by the Board of Visitors of the
University of Virginia, Professor of Anatomy, Physiology, and Surgery, in
that flourishing Institution. Dr. W. has been delivering with great reputation
private lectures on Anatomy and Physiology in Baltimore for the last four years,
and he will, no doubt, do honour to himself and to the Institution to which he
is now attached.
New Publications. — We have been requested to announce, that Dr. J. R.
CoxE, Professor of Materia Medica in the University of Pennsylvania, has in
press and will speedily publish a work, entitled " An Inquiry into the Claims of
Dr. Harvey to the Discovery of the Circulation of the Blood; wherein is Demon-
strated the Injustice of those Claims, and an Attempt made to place this Dis-
covery on a more Equitable Footing."
Also that Dr. Alexaintder C. Draper is preparing for publication, "A Trea-
tise on Mania a Potu, containing Observations on its History, Pathology, Symp-
toms, mode of Treatment, &c. with Preliminary Inquiries into the Nature and
Lav/s of Irritability or Organic Force."
We shall take the earliest opportunity after their publication of making our
readers acquainted with these works.
INDEX.
Abortion, Granville on, 414.
Albers on spontaneous perforations of oeso-
phagus and trachea, 471.
Alegre's case of meningeal apoplexy, 232.
Alkaloids, new, 516,
Amaurosis, 498.
Amputation of thigh, 255.
with single flap, 506.
Anatomy of eye, remarks on, 216.
Anseraia of kidneys, case of, 220.
Angustura bark, cusparia from, 266.
Anus, case of absence of, 215.
Apoplexy, case of meningeal, 232.
— — of spinal marrow, 232.
Ar^pabaca, new anthelmintic, 482.
Atrophy of left half of tongue, case of, 235.
Aubergier's pomatum, 240.
Axillary aneurism, ligature of subclavian
for, 530.
Azote, presence of, in seeds, 522.
B.
Batka on active principle of sarsaparilla,
483.
Beauchamp on porrigo decalvans, 497.
Beatty on mammary abscess, 496.
Beaumont on digestion, 117.
Belden's account of the Springfield som-
nambulist, 445.
Belladonna in pertussis, 364.
Berton on amaurosis, 498.
Beyer's case of life and respiration after
destruction of brain, 220.
Biancini on the sanguineous connexion of
mother and foetus, 459.
Biett's ointment for cure of porrigo, 240.
Bilious remittent fever, Dudley on, 76.
Bladder, catarrh of, copaiva in, 13.
Blandin's case of excision of lower jaw,
506.
Blisters, Stokes on the use of, 494.
Boswell's case of swelled leg, 234.
Boudet's researches on the composition of
serum, 518, 521.
Bouillaud on pathology of typhus fever,
465.
on follicular enteritis, 467.
Bourjot on nutrition and diseases of the
eye, 501.
Brachet, tardy appearance of vaccine pus-
tule, 474.
Brain, case of life and respiration after de-
struction of, 220.
congenital malformation of, 462.
Buisson on hydrophobia, 497.
Cesarean operation, 261.
- section, 258.
Gaffe's case of destruction of the neck of
the uterus, &c. 509.
Campbell's case of tumour of external ear,
234.
CarsweU's illustrations of the elementary
forms of disease, 418.
Cassanova on madder, 213.
Cascarilla bark, plant which yields, 480.
Cataplasms, 484.
Catarrh of the bladder, copaiba in, 13.
Cerebral affections of children, 99.
Cerebro-spinal liquid, 478.
Cha])man on tic douloureux, 289.
Charlton's cases of gastritis, 74.
Chevallier on cataplasms, 484.
Choisy on functions of lingual nerves, 219.
Chlorine, use of, in pulmonary affections,
243.
Cholera on Folly Island, 377.
Chronic bronchitis, treatment of, 244.
gastritis, 469.
Clavicle, extirpation of necrosed, 250.
reproduction of, after extirpation,
250.
Cook's case of fistulous opening of sto-
mach, 271.
Cooper on fractures of the neck of the
tkigh bone, 504.
Copaiba, La Roche on remedial effects of,
13.
Copland's dictionary of practical medi-
cine, 209.
Craigie on paraplegia, 227.
on pulmonary emphysema, 472.
's case of myelitic paraplegia, 229.
's case of periostitis with ozcena.
230.
244.
■'s case of melcena, 232.
-'s treatment of chronic bronchitis,
Cramer's case of epispadia, 461.
Cranium, sanguineous humours of, 254.
Cusparia obtained from angustura bark,
266.
D.
Death fi'om hemorrhage from an ulcer of
the stomach, 474.
Dieffenbach's treatment of fractured limbs,
503.
Delivery, impediments to, from malforma-
tions of foetus, 511.
Deschamps's case of congenital malforma-
tion of the brain, 462.
532
INDEX.
Dictionary of practical medicine, Cop-
land's, 209.
Digestion, experiments on, 117.
— — observations on, 201.
Digestive system, pathology of diseases of,
237.
Don on the plant which yields the casca-
rilia bark, 480.
Dudley on bilious remittent fever, 76.
Dunglison's address of 1834, 272.
table of doses, &c. of medi-
cines, 530.
Dupuytren on resection of bones in un-
united fractures, 502.
Dysentery, 443.
Ear, pendulous tumour of, 234.
Earle on the functions of the nerves, 188.
Edwards on the influence of physical agents
on life, 150.
Elephantiasis, Pennock on, 347.
Emphysema, pulmonary, 472.
Engorgement of occipital and vertebral
ligament, 235.
Epidemic gastric fever, observations on,
222.
Epispidia, 461.
Epsom salt, improved method of adminis-
tering, 240.
Ergot in case of adhesion of placenta to
uterus, 267.
Eve, medical education in Georgia, 523.
Eye, anatomy of, 216.
■ nutrition and diseases of, 501.
F.
Fattori on the use of the trepan in tooth-
ache, 502.
Fever, pathology of, 271.
Finley's remarks on lithotomy, 382.
Fistula in ano. Mutter's new instrument
for, 80.
l^iorida, climate of, 267.
Follicular enteritis, 467.
Fracture of thigh, 255.
of OS humeri, 270.
ununited, 372.
Fractures, treatment of, by inclosing limb
in plaster moulds, 503,
■ of the neck of the thigh bone,
504.
G.
Galvanism, in paralysis, 321.
■ in neuralgia, 384.
Gastritis, 74, 469, 485.
Gastric fever, 222.
Georgia, medical education in, 523.
Gerhard's cases of cerebral affections of
children, 99.
on pneumonia of children, 328.
Gillespie's cases of neuralgia, 115.
Guaiacum, extract of, 483.
H.
Harris's cases of yellow fever, 41.
cases of neuralgia, 384.
Harrison on fever, 271.
Henry's mode of administering Epsom
salt, 240.
Hepatic abscess, 87.
Heyfelder's case of inguinal hernia, 253.
case of vagitus uterinus, 463.
Horner's case of hepatic abscess, 87.
Huston's case of hypertrophy of mammae,
374.
Hypertrophy of mammse, 374.
- of muscular coat of stomach,
221.
Hydriodate of iron, formulse for prepara-
tions of, 240.
Hydrocele cured by iodine, 501.
Hydrophobia, 497.
Hydrocyanic acid, test for, 264.
I.
Iliac vein, obliteration of, 234.
Inguinal hernia, case of strangulated, 253,
Intestines, ulcers of cicatrized, 477.
Iodine in mercurial salivation, 243.
in hydrocele, 501.
Iron, forrbulse for preparations of hydrio-
date of, 240.
J.
Jackson's case of purpura hssmorrhagia,
95.
'—— on belladonna in pertussis, 364.
Jones' case of accumulation of air in ute-
rus, 510.
K.
Kidneys, ansemia of, 220.
Keckeley on the cholera of Folly Island,
377.
King on opium in bowel affections, 443.
Kuhn's theory of the formation of tuber-
cles, 478.
L.
La Roche on copaiba, 13.
Laming on preparation of prussic acid, 263.
Legros, method of amputation, 506.
Leg, swelled condition of, with oblitera-
tion of iiiac vein, 234.
Leucorrhoea, remedial effects of copaiba
in, 30.
Life, influence of physical agents on, 150.
Ligaments, case of engorgement of occipi-
tal and vertebral, 235.
Ligature of common iliac, 529.
on subclavian artery below cla-
vicle, 253.
Lingual nerves, functions of, 219,
Lithotomy, Finley on, 382.
statistics of, 516.
Lower jaw, excision of, 506.
Luxation of inferior maxillary bone, 252.
INDEX.
533
Luxation of pubis, 261 .
Lymphatic vessels, structure and functions
of, 464.
M.
Madder, use of, in ulcers, 249.
Cassanova on, 213.
Magill on typhus fever, 444.
Malformation, case of, 215.
Mammary abscess, 496.
Mammse, hypertrophy of, 374.
— and uterus, sympathy between,
462.
Maxillary bone, luxation of inferior, 252.
Mayo on diseases of rectum, 435.
Meningeal apoplexy, case of, 232.
Melosna, case of, 232.
Meyer's case of extirpation of clavicle, fol-
lowed by reproduction of bone, 250.
Mielitic paraplegia, case of, 229.
Miguel on means of preventing scarlatina,
479.
Miller on galvanism as a therapeutic agent,
324.
Mitchell, lecture by, 272.
Mojon on structure and functions of lym-
phatic vessels, 464.
Monod's case of spinal apoplexy, 232.
Montault's case in which thirteen ounces
of cerebro-spinal liquid was found, 478.
on functions of lingual nerves,
219.
Mother and foetus, sanguineous connexion
of, 459.
Mott's surgical operations, 529, 530.
Monestier's case of death from hsemor-
rhage from stomach, 474.
Mutter's instrument for fistula in ano, 80.
N.
Neck, tumours of, 526.
Nerves, functions of, 188.
tubercles developed in, 219.
Nelaton's case of development of tubercles
in nerves, 219.
Neuralgia, 115, 245, 289, 384, 497.
Nichols case of spinal irritation, 524.
Noverre on arapabaca, 482.
O.
Opium, 242.
(Esophagus forceps. 111.
spontaneous perforation of, 471 .
■ diverticulum of, 461.
Os humeri, fracture of, 270.
Osteo-sarcoma of lower jaw, 506.
Otto's case of displacement of orifice of
urethra, 462.
case of hypertrophy of muscular
coat of stomach, 221.
Ozoena, case of, 230.
P.
Palsy of tongue, case of, 235.
Paralysis, galvanism in, 321.
Paraplegia dependent on chronic inflam-
mation of spinal cord, 227.
Parrish's case of ununited fracture, 372.
Parturition, case of difficult, 259.
Parturient pains, remarkable location of^
270.
Pelvis, division of, in difficult parturition,
259.
Pendulous tumour of external ear, 234.
Pennock on elephantiasis, 347.
Pertussis, belladonna in, 364.
Perrine on climate of Florida, 267.
Periostitis with ozoena, case of, 230.
Peygot's case of anomaly in venous system^
218.
Pierquin's formula for hydriodate of iron,
240.
Piorry on neuralgia, 245.
Placenta, adhesion of, to fundus of uterus,
ergot in, 267.
— means of promoting expulsion of,
462, 463.
Pneumonia of children, 328.
Poole on epidemic gastric fever, 222.
Porrigo, ointment for cure of, 240.
decalvans, 497.
Prussic acid, new method of preparing,
263.
Pubis, luxation of, 262.
Publications, new, 530.
Pulmonary affection, chlorine in, 243.
Purpura hsemorrhagia, case of, 95.
R.
Recto-vaginal canal, case of, 215.
Rectum, stricture of, tent in, 255.
- diseases of, 435.
Renzi's statistics of lithotomy, 516.
Respiration, existence of, after destruction
of brain, 220.
Ricord'scase of malformation, 215.
treatment of hydrocele, 501.
Richelot on febrifuge properties of salicine,
482.
Rigby's method of promoting the expulsion
of placenta, 462.
Roux's lotion for neuralgia, 497.
S.
Salicine, febrifuge properties of. 482.
Sanguineous tumours of cranium, 254.
Sarsaparilline, 516.
Sarsaparilla, active principle of, 483.
Scarlatina, means of preventing, 478.
Sedillot's case of ulcers of intestines cica-
trized, 477.
Seeds, presence of azote in, 522.
Serum, on the composition of, 518, 521.
Smith's cases of tumours of the neckj
526.
Somervail on suppression of urine, 113.
Somnambulist, Springfield, 445.
Soubeiran on extract of guaiacum, 483.
45*
534
INDEX.
South Caroliaa Medical College, 530.
Spencer on dysentery, 443.
Spinal cord, inflammation of, causing para-
plegia, 227.
— — marrow, apoplexy of, 232.
■■ irritation, 524.
column, malformation of, 258.
Statistics, medical, of various countries in
Europe, 513.
Stokes on local diseases, 237.
■ on blisters, 494.
. on delirium tremens, 495.
on chronic gastritis, 469, 488.
on acute gastritis, 485.
Stomach, hypertrophy of muscular coat of,
221.
fistulous opening of, 271.
ulcer and haemorrhage of, 474.
Strangulated hernia, case of operation,
253.
Stricture of rectum, 255.
Strom eyer's case of luxation of inferior
maxilla, 252.
Subclavian, ligature of, 530.
artery, ligature of, 253.
Sulphate of quinine and tobacco in inter-
mittent head-aches, 243.
Suppi'ession of urine, case of, 113.
Superfostation, case of, 220.
T.
Tanchou's case of stricture of rectum, 255.
Tic douloureux, 289.
Ticknor's anomalous case, 91-
Thigh, compound fracture of, 255.
Thubeuf on sarsaparilline, 516.
Tobacco and sulphate of quinine as snuff
used in intermittent head-aches, 243.
Tongue, palsy and atrophy of, 235.
Tooth-ache, 502.
Trachea, spontaneous perforations of, 471 .
Trepan in tooth-ache, 502.
Transactions of the Medical Society of
New York, 442.
Transylvania University, 530.
Trustedt's case of contraction of uterus
after death, 465.
Tubercles developed in nerves, case of, 219. 1
Tubercles, new theory of the formation of,
478.
Tumour of external ear, 234.
TurnbuU on veratria, 440.
Turning, by head, advantages of, 261.
Twining on opium, 242.
Typhus fever, Magill on, 444.
fever, pathology of, 465.
U.
Ulcers, use of madder in, 249.
of intestines, cicatrix of, 477.
University of Pennsylvania, 272.
of Maryland, 272.
Ununited fractures cured by friction, 372.
iodine in, 444.
' resection of bones in ,
502.
Urethra, displacement of orifice of, 462.
Uterus, destruction of neck of, 509.
accumulation of air in, 510.
and mammse, sympathy between.
462.
contraction of, after death, 465.
V.
Vaccination, tardy development of, 474.
repeated in Prussian army.
474.
repeated, question of, 475.
Vaginal Csesarean operation, 509.
Vagitus uterinus, 463.
Venous system, anomaly in, 218.
Velpeau*s ovology, 389.
Veratria, TurnbuU on, 440.
Virginia, university of, 530.
Voisin on digestion, 201.
W.
Waldo on cold applications in local inflam-
mation, 443.
Weever's esophagus forceps, 111.
Willouby on utility of iodine in ununited
fractures, 444.
Wynn's case of anasmia of kidneys, 220.
Y.
Yellow fever, cases of, 41.
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